Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux

Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey Slezak, Yuri Reinberg

Research output: Contribution to journalArticle

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Abstract

Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. Materials and Methods: All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. Results: The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). Conclusions: Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

Original languageEnglish (US)
Pages (from-to)1707-1710
Number of pages4
JournalJournal of Urology
Volume178
Issue number4 SUPPLEMENT
DOIs
StatePublished - Oct 2007

Fingerprint

Vesico-Ureteral Reflux
Hyaluronic Acid
Pediatrics
Injections
Giant Cells
Fibrosis
Serous Membrane
Lymphocyte Count
Hematoxylin
Eosine Yellowish-(YS)
Ureter
dextranomer
Staining and Labeling
Inflammation

Keywords

  • fibrosis
  • hyaluronic acid
  • inflammation
  • ureter
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

Routh, J. C., Ashley, R. A., Sebo, T. J., Vandersteen, D. R., Slezak, J., & Reinberg, Y. (2007). Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux. Journal of Urology, 178(4 SUPPLEMENT), 1707-1710. https://doi.org/10.1016/j.juro.2007.03.165

Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux. / Routh, Jonathan C.; Ashley, Richard A.; Sebo, Thomas J.; Vandersteen, David R.; Slezak, Jeffrey; Reinberg, Yuri.

In: Journal of Urology, Vol. 178, No. 4 SUPPLEMENT, 10.2007, p. 1707-1710.

Research output: Contribution to journalArticle

Routh, JC, Ashley, RA, Sebo, TJ, Vandersteen, DR, Slezak, J & Reinberg, Y 2007, 'Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux', Journal of Urology, vol. 178, no. 4 SUPPLEMENT, pp. 1707-1710. https://doi.org/10.1016/j.juro.2007.03.165
Routh, Jonathan C. ; Ashley, Richard A. ; Sebo, Thomas J. ; Vandersteen, David R. ; Slezak, Jeffrey ; Reinberg, Yuri. / Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux. In: Journal of Urology. 2007 ; Vol. 178, No. 4 SUPPLEMENT. pp. 1707-1710.
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N2 - Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. Materials and Methods: All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. Results: The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). Conclusions: Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

AB - Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. Materials and Methods: All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. Results: The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). Conclusions: Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

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