The influence of interstitial cells of Cajal density in the outcomes of pyeloplasty in adults: A prospective analysis

Abstract

Purpose:

To evaluate if the density of interstitial cells of Cajal (ICC) in the ureteropelvic junction (UPJ) influences the outcomes of pyeloplasty in adults.

Methods:

Twenty-three patients with the diagnosis of ureteropelvic junction obstruction (UPJO) that underwent laparoscopic dismembered pyeloplasty were included. ICC density was measured using immunohistochemistry reaction for c-KIT expression in the resected UPJ segment. Pyeloplasty outcome was evaluated by patient self-report pain, urinary outflow using DTPA renogram and hydronephrosis assessment using ultrasound (US) at 12 months of follow-up. A logistic regression analysis was performed to assess the association of pyeloplasty outcomes and ICC density.

Results:

Low, moderate, and high ICC density were present in 17.4%, 30.4%, and 52.2% of the patients, respectively. Complete pain resolution was observed in 100%, 85.7%, and 75% of patients with low, moderate and high ICC density, respectively (p = 0.791). DTPA renogram improved in 75%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.739). Hydronephrosis improved in 25%, 85.7%, and 91.7% of patients with low, moderate and high ICC density, respectively (p = 0.032).

Conclusions:

Patients with high ICC density have a significant amelioration of hydronephrosis after pyeloplasty. However, ICC density is not associated with functional outcomes.

Keywords

Interstitial cells of Cajal pyeloplasty ureteropelvic obstruction outcomes laparoscopic

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References

Carr

El-Ghoneimi

, et al. Anomalies and surgery of the ureteropelvic. In: Wein

Kavoussi

Novick

(eds) Campbell e Walsh Urology. Philadelphia, PA: W.B. Saunders, 2012, 9th ed, pp.94–95.

Woodward

Frank

Postnatal management of antenatal hydronephrosis. BJU Int 2002; 89: 149–156.

Nerli

Jayanthi

Reddy

, et al. Pelvi-ureteric junction obstruction with crossing renal vessels: a case report of failed laparoscopic vascular hitch. J Pediatr Urol 2009; 5: 147–150.

Metzger

Schuster

Till

, et al. Cajal-like cells in the human upper urinary tract. J Urol 2004; 172: 769–772.

Di Benedetto

Arena

Nicotina

, et al. Pacemakers in the upper urinary tract. Neurourol Urodyn 2013; 32: 349–353.

Solari

Piotrowska

Puri

Altered expression of interstitial cells of Cajal in congenital ureteropelvic junction obstruction. J Urol 2003; 170: 2420–2422.

Brading

McCloskey

KD.

Mechanisms of disease: specialized interstitial cells of the urinary tract—an assessment of current knowledge. Nat Clin Pract Urol 2005; 2: 546–554.

Balikci

Turunç

Bal

, et al. Comparison of Cajal-like cells in pelvis and proximal ureter of kidney with and without hydronephrosis. Int Braz J Urol 2015; 41: 1178–1184.

Noble

Brown

DF.

Renal ultrasound. Emerg Med Clin North Am 2004; 22: 641–659.

10.

Eden

Cahill

Allen

JD.

Laparoscopic dismembered pyeloplasty: 50 consecutive cases. BJU Int 2001; 88: 526–531.

11.

Koleda

Apoznanski

Wozniak

, et al. Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction. Int Urol Nephrol 2012; 44: 7–12.

12.

Cajal

SR.

Sur les ganglions et plexus nerveux d’intestin. CR SocBiol 1893; 5: 217–223.

13.

Klemm

Exintaris

Lang

RJ.

Identification of the cells underlying pacemaker activity in the guinea-pig upper urinary tract. J Physiol 1999; 519: 867–884.

14.

David

Cebrian

Vaughan

Jr , et al. C-kit and ureteral peristalsis. J Urol 2005; 173: 292–295.

15.

Kuzgunbay

Doran

Bayazit

, et al. The effects of ureteral obstruction on Cajal-like cells in rats. J Pediatr Urol 2009; 5: 269–273.

16.

Huizinga

Zarate

Farrugia

Physiology, injury, and recovery of interstitial cells of Cajal: basic and clinical science. Gastroenterology 2009; 137: 1548–1556.

17.

Al-Shboul

OA.

The importance of interstitial cells of Cajal in the gastrointestinal tract. Saudi J Gastroenterol 2013; 19: 3–15.

18.

Mehrazma

Tanzifi

Rakhshani

Changes in structure, interstitial Cajal-like cells and apoptosis of smooth muscle cells in congenital ureteropelvic junction obstruction. Iran J Pediatr 2014; 24: 105–110.

19.

Senol

Onaran

Gurocak

, et al. Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol 2016; 12: 89.e1–89.e5.

20.

Kojima

Umemoto

Mizuno

, et al. Comparison of laparoscopic pyeloplasty for ureteropelvic junction obstruction in adults and children: lessons learned. J Urol 2011; 185: 1461–1467.

21.

Rehman

Landman

Sundaram

, et al. Missed anterior crossing vessels during open retroperitoneal pyeloplasty: laparoscopic transperitoneal discovery and repair. J Urol 2001; 166: 593–596.

22.

Yiee

Johnson-Welch

Baker

, et al. Histologic differences between extrinsic and intrinsic ureteropelvic junction obstruction. Urology 2010; 76: 181–184.

23.

Richstone

Seideman

Reggio

, et al. Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology 2009; 73: 716–719.

24.

Ozayar

Friedlander

Shakir

, et al. Equivocal ureteropelvic junction obstruction on diuretic renogram–should minimally invasive pyeloplasty be offered to symptomatic patients? J Urol 2015; 193: 1278–1282.

25.

Romao

Farhat

Pippi Salle

, et al. Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction. J Urol 2012; 188: 2347–2353.

26.

Cost

Prieto

Wilcox

DT.

Screening ultrasound in follow-up after pediatric pyeloplasty. Urology 2010; 76: 175–179.

27.

Arap

Torricelli

FCM

Mitre

, et al. Lessons from 90 consecutive laparoscopic dismembered pyeloplasties in a residency program. Scand J Urol 2013; 47: 323–327.