Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses

Ellerkamp, Verena; Kurth, Ralf-Rainer; Schmid, Evi; Zundel, Sabine; Warmann, Steven W.; Fuchs, Jörg

doi:10.1007/s00345-015-1645-x

Cited by 29 publications

(25 citation statements)

References 35 publications

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“…This study is performed immunohistochemically on postnatal human subjects and we consider that the explanation may be the reactivation of the processes, which had shown their effects in the embryological period and then had stopped, probably due to the chronic inflammation and long-term micro-trauma caused by disturbances of urine flow in UPJ obstruction, an argument hitherto, mentioned a few times in the literature. 13 , 14 Naturally, to prove this hypothesis in such a mysterious area with limited literature information, further investigations are required. In addition, since this is an immunohistochemical study, it is needed to show, whether protein expression reflects the molecular changes of these genes.…”

Section: Discussionmentioning

confidence: 99%

Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction

Yılmaz

Neşe

Dalgıç

et al. 2016

SMJ

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Objectives:To compare pathological samples obtained from cases that underwent surgery for ureteropelvic junction (UPJ) obstruction with samples obtained during autopsies of subjects.Methods:Retrospectively, 42 patients who had undergone surgery due to UPJ obstruction (group 1) were included in the study. Histopathological and immunohistochemical features for sonic hedgehog (SHH), TBX18, and TSHZ3 of UPJ were evaluated and findings were compared with 20 autopsy cases (group 2).Results:In group 1, the scores were statistically significantly higher in terms of cytoplasmic SHH, nuclear TBX18, cytoplasmic and nuclear TSHZ3 staining. Statistically, no correlation was found between age and the staining scores belonging to these 3 antibodies in group 1 and group 2. Intense inflammation was found to be related with nuclear staining for TBX18.Conclusion:Gene product expressions of SHH, TBX18 and TSHZ3 are statistically higher in patients with UPJ obstruction, when compared with control group. The explanation may be the reactivation of the processes, which had shown their effects in the embryological period, due to the chronic inflammation and long-term micro-trauma created by the disease.

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Section: Discussionmentioning

confidence: 99%

Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction

Yılmaz

Neşe

Dalgıç

et al. 2016

SMJ

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“…In der genannten Studie von Mut et al ähnelten sich die immunhistochemischen Profile der Resektate von intrinsischen und extrinsischen Obstruktionen nach Durchführung einer Nierenbeckenplastik. Dies bestätigt die bereits o. g. Befunde von Ellerkamp et al, deren Patienten mit Polgefäß gleiche histopathologische Veränderungen am uretero-pelvinen Übergang aufwiesen wie Patienten mit einer intrinsischen Stenose [13]. Daher erscheint die Selektion der Patienten intraoperativ, anhand von subjektiven Wahrnehmungen, der Beurteilung der Peristaltik und der Volumenabnahme des Nierenbeckens unsicher bzw.…”

Section: Postoperativ Persistierende Obstruktion Nach "Vascular Hitch"unclassified

Subpelvine Stenose/Kreuzendes Gefäß – kontra vascular hitch

2020

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ZusammenfassungDie Hydronephrose beim Kind ist zumeist bedingt durch eine (kongenitale) intrinsische Ureterabgangsstenose. Die von Anderson und Hynes etablierte „dismembered“ Nierenbeckenplastik stellt den Goldstandard in der operativen Therapie dar, sei es über einen offenen Zugang oder laparoskopisch (auch robotisch assistiert) bzw. retroperitoneoskopisch durchgeführt. Weniger häufig findet man – zumeist bei Patienten jenseits des Säuglingsalters − eine extrinsische Stenose als Ursache einer – dann zumeist – intermittierenden bzw. dynamischen Hydronephrose. Diese wird verursacht durch ein oder mehrere aberrierende Unterpolgefäße, welche den uretero-pelvinen Übergang obstruieren. Hierfür ist die operative Verlagerung des Gefäßes durch eine Tunnel-Plastik am Nierenbecken, die sog. „vascular hitch“-Operation, von Hellström beschrieben, in zunehmender Weise wieder etabliert worden. Die beiden Möglichkeiten der operativen Therapie werden nach wie vor kontrovers diskutiert. In der Literatur findet sich Evidenz dafür, dass bei Vorliegen eines Polgefäßes in bis zu 57 % zusätzlich eine intrinsische Stenose ist, in bis zu 100 % zumindest histologische Alterationen wie bei einer intrinsischen Stenose vorhanden sind. Der intraoperative Aspekt erlaubt keine Diskriminierung zwischen intrinsischer und extrinsischer Stenose, diese kann nur histologisch objektiviert werden. Bei der Durchführung eines „vascular hitch“ besteht daher das Risiko einer verbleibenden intrinsischen Stenose mit konsekutiver Abflussstörung und der Gefahr einer Partialfunktionsminderung. Auch kann durch den „vascular hitch“ selbst die Durchblutung der Niere kompromittiert werden. Die sog. „dismembered“ Nierenbeckenplastik vermeidet hingegen ein falsches Selektionieren der Patienten. Zudem ist sie mit hinreichender Evidenz belegt als ein Verfahren mit niedriger Komplikationsrate von 2 – 3 % und funktionell sehr guten Ergebnissen hinsichtlich des Erhalts der Partialfunktion und der Verbesserung der Abflussdynamik. Im Vergleich besteht in der Literatur kein vermehrtes Komplikationsrisiko gegenüber der „vascular hitch“-Operation. Daher bevorzugen wir die "dismembered" Nierenbeckenplastik als Methode der Wahl bei der Hydronephrose und dem Vorliegen eines aberrierenden Polgefäßes.

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“…Hydronephrosis is the impairment of urinary flow from the renal pelvis to the ureter. Most cases are caused by intrinsic factors, such as an aperistaltic ureteral segment, infoldings of the ureteral wall or true strictures [1]. Extrinsic forms of uretero-pelvic junction obstruction (UPJO) include the presence of an aberrant crossing vessel (CV), kinkings or fibrous bands over the uretero-pelvic junction (UPJ) [2,3].…”

Section: Introductionmentioning

confidence: 99%

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

et al. 2020

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Purpose Uretero-pelvic junction obstruction is the most common cause of prenatal hydronephrosis. It can be intrinsic, extrinsic due to crossing vessel (CV) or mixed. This paper aims to present the surgical outcome in a single pediatric thirdlevel center. Methods A retrospective analysis of all children operated between 2011 and 2018 was conducted. Demographic information, pre-operative pelvic antero-posterior diameter (APD), intra-operative parameters, hospital stay and follow-up were considered. Re-do operations and success rate for Vascular Hitch (VH), open and laparoscopic pyeloplasties were recorded. Results 128 patients were included. The mean pre-operative APD was 30 mm. The etiology was intrinsic in 71.9%, extrinsic in 25.0% and mixed in 3.1%. The median age between intrinsic and extrinsic groups was statistically different. Thirty-one VH, 88 dismembered and 9 non-dismembered pyeloplasties were performed. The median hospital stay was 2 days for VH and 6 for pyeloplasties. The median hospital stay was statistically longer in open pyeloplasties compared to laparoscopic. The mean post-operative APD was 14 mm. The success rate after VH was 90.3%, after open pyeloplasties 97.9% and after mini-invasive pyeloplasties 91.8%. Conclusions VH could be a good option in the treatment of hydronephrosis due to CV, laparoscopic pyeloplasties have equivalent success rate and shorter hospital stay than open pyeloplasties.

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Differences between intrinsic and extrinsic ureteropelvic junction obstruction related to crossing vessels: histology and functional analyses

Abstract: We could not find any significant histological differences between CV and IUPJO in children. To obtain excellent functional recovery, surgical procedures with a definite correction of the UPJ should be preferred in paediatric patients with CV.

Cited by 29 publications

References 35 publications

Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction

Sonic hedgehog, TBX18, and TSHZ3 proteins involved in pyeloureteral motility development are overexpressed in ureteropelvic junction obstruction

Subpelvine Stenose/Kreuzendes Gefäß – kontra vascular hitch

Uretero-pelvic junction obstruction with and without crossing vessels: surgical outcome in a single center experience

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