Relationship of histopathological changes in ureterovesical junction with clinical course in primary megaureters in childhood.

Year 2021, , 221 - 224, 20.09.2021

Mehmet Uysal

https://doi.org/10.54005/geneltip.996505

Abstract

INTRODUCTION: It was aimed to understand etiopathogenesis and to estimate the clinical course of the primary megaureter (PMGU).
METHODS: Twenty-two patients (11 male,11 female) who underwent PMGU were separated into three groups according to the operation age Group I (0-9 months), group II (10-24 months), group III (24 months). All groups were compared using histopathological and clinical data between June 1999-May 2009.
RESULTS: All group II patients either to ascertain significant improvement in terms of changes in renal anterior-posterior (APD), üreter diameter. A poor positive-relation without any statistical significance was found between neural fiber cell count and APD, ureter diameter, parenchyma thickness (PT) whereas the relation between the number of neural fiber cell count and changes in split function (SF) was reverse, but this relation wasn’t statistically significant (p>0.05).
DISCUSSION AND CONCLUSION: Although endoscopic and surgical techniques are successful for managing PMGU, we thought early intervention may have undesirable consequences.It is determined that the operations, which are done after 9 and more months, are more effective to protect renal functions in the cases of PMGU.

Keywords

primary megaureter, uretrovesical stenosis, childhood, hydroureteronephrosis

Çocukluk çağı primer megaüreterlerinde, üreterovezikal bileşkedeki histopatolojik değişikliklerin klinik gidiş ile ilişkisi

Abstract

GİRİŞ ve AMAÇ: Primer megaüreter (PMGÜ)’ in etyopatogenezini anlamak ve klinik seyrini tahmin etmek amaçlandı.
YÖNTEM ve GEREÇLER: PMGÜ sebebiyle takip edilen yirmi iki hasta (11 erkek,11 kadın) operasyon yaşına göre üç gruba ayrıldı: Grup I (0-9 ay), Grup II (10-24 ay), grup III (>24 ay). Tüm gruplar Haziran 1999-Mayıs 2009 tarihleri arasında histopatolojik ve klinik veriler kullanılarak karşılaştırıldı.
BULGULAR: Tüm grup II hastaları,böbrek ön arka çapı (RPÇ), üreter çapındaki değişiklikler açısından anlamlı iyileşme tespit edildi. Nöral lif hücre sayısı ile RPÇ, üreter çapı, parenkim kalınlığı (PT) arasında istatistiksel olarak anlamlı olmayan zayıf bir pozitif ilişki bulunurken, nöral lif hücre sayısı ile bölünmüş böbrek fonksiyonları (BBF)’ndaki değişiklikler arasındaki ilişki ters idi, ancak bu ilişki istatistiksel olarak anlamlı değildi (p>0.05)
TARTIŞMA ve SONUÇ: PMGÜ'yü yönetmek için endoskopik ve cerrahi teknikler başarılı olmakla birlikte, erken müdahalenin istenmeyen sonuçlara neden olabileceğini düşündük. PMGÜ olgularında 9 ay ve daha sonra yapılan operasyonların böbrek fonksiyonlarının korunmasında daha etkili olduğu belirlenmiştir.

Keywords

primer megaüreter, üreterovezikal darlık, çocukluk çağı, hidroüreteronefroz

References

• Akdağ A,Ozalkaya E, Erdogan E,Oren A,Kaya M.Early intervention in a newborn with primary obstrutive megaureter.Ped Urol Case Rep;2014:1(4):8-15
• Hanna MK, Jeffs RD, Sturgess JM, et al. Ureteral structure and ultrastructure. Part 1.The normal human ureter. J Urol 1976;116:718-720.
• Mc Laughlin AP, Pfister RC, Leadbetter WF, et al. The pathophysiolgy of primary megaloureter. J Urol 1973;109:805-811.
• Dixon JS, Jen PYP, Yeung CK, et al. The vesicoureteric junction in three cases of primary obstructive megaureter associated with ectopic ureteric insertion. Br J Urol 1998;81:580-584.
• Nicotina PA, Romeo C, Arena F, et al. Segmental up regulation of transforming growth factor-B in the pathogenesis of primary megaureter. An immunocytochemical study. Br J Urol 1997;80:946-949.
• Diebel LN,Schein M, Wittmann MH, et al. Identification of the cells underlying pacemaker activity. J Urol;1998;11:1859-1916.
• Oswald J, Schwenther C, Brenner E, et al: Extracelluler matrix degradation and reduce nerve supply in refluxing ureteral endings. J Urol 2004;172:1099-1102.
• Allen TD. Congenital ureteral strictures. J Urol 1970;104:196-199
• Solari V, Piotrowska AP, Puri P et al. Altered expression of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. J Urol 2003;170:2420.
• Meyer JS, Lebowitz RL. Primary megaureter in infants and children: A review. Urol Radiol 1992;14:296-305.
• Notley RG. Electron microscopy of the primary obstructive megaureter. Br J Med 1972;44:229-234.
• Hanna MK, Jeffs RD, Sturgess JM, et al. Ureteral structure and ultrastructure. Part 3. The congenitally dilated ureter (megaureter). J Urol 1977;117:24-27.
• Smith ED, Cussen LJ, Glenn J, et al. Report of working party to establish an international nomeclature for the large ureter. J Urol 1977;13:3-8
• Farrugia MK, Hitchcock R, Radford A, Burki T, Robb A, Murphy F; British Association of Paediatric Urologists. British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol. 2014;10:26- 33
• Shokeir AA, Nijman RC. Primary megaureter: current diagnosis and treatment.BJU Int.2000;86:861-68.
• Mollard P, Foray P, De Godey GL, et al. Management of primary obstructive megaureter without reflux in neonates. Eur Urol 1993;14:505-510.
• Koff SA, Campbell K. Nonoperative management of unilateral neonatal hydronephrosis. J Urol 1992;148:525
• King LR, Coughlin PWF, Bloch EC, et al. The case for immediate pyeloplasty in the neonate junction obstruction. J Urol 1984;132: 725-727.
• Peters CA, Mandell J, Lebowitz RL, et al. Congenital obstructed megaureters in early infancy: diagnosis and treatment. J Urol 1989;142: 641-645.
• Keating MA. A different perspective of the perinatal primary megaureter. In: Kramer SA (ed), Problems in Urology. JB Lippincott , Philadelphia,1990:583-585