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 language | English (US) |
|---|---|
| Pages (from-to) | 1707-1710 |
| Number of pages | 4 |
| Journal | Journal of Urology |
| Volume | 178 |
| Issue number | 4 SUPPLEMENT |
| DOIs | |
| State | Published - Oct 2007 |
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Keywords
- fibrosis
- hyaluronic acid
- inflammation
- ureter
- vesico-ureteral reflux
ASJC Scopus subject areas
- Urology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Histopathological Changes Associated With Dextranomer/Hyaluronic Acid Injection for Pediatric Vesicoureteral Reflux
AU - Routh, Jonathan C.
AU - Ashley, Richard A.
AU - Sebo, Thomas J.
AU - Vandersteen, David R.
AU - Slezak, Jeffrey
AU - Reinberg, Yuri
PY - 2007/10
Y1 - 2007/10
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.
KW - fibrosis
KW - hyaluronic acid
KW - inflammation
KW - ureter
KW - vesico-ureteral reflux
UR - http://www.scopus.com/inward/record.url?scp=34548434738&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548434738&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2007.03.165
DO - 10.1016/j.juro.2007.03.165
M3 - Article
C2 - 17707018
AN - SCOPUS:34548434738
VL - 178
SP - 1707
EP - 1710
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 4 SUPPLEMENT
ER -