Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy

Jamil Rehman, Maged M. Ragab, Ramakrishna Venkatesh, Chandru Sundaram, S. Ali Khan, Troy Sukkarieh, David Samadi, Bilal Chughtai, Francis White, David Bostwick, Wayne Waltzer

Research output: Contribution to journalArticle

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Abstract

Background and Purpose: Endopyelotomy is the preferred treatment for ureteropelvic junction (UPJ) obstruction because of its short operating time, limited morbidity, fast recovery, and reasonable efficacy. We used tissue and immunohistochemistry staining and electron microscopy to look at the muscle regeneration following an endopyelotomy incision in a porcine model. Materials and Methods: Bilateral electrosurgical endopyelotomy was performed in six domestic pigs with placement of 7F 20-cm Percuflex® double-J stents for up to 4 weeks, and urinary tracts were harvested at 3 or 5 months. Specimen evaluation included tissue staining with hematoxylin-eosin, Masson's trichrome, and Verhoeff's iodine and Van Gieson solution; histochemical staining for smooth-muscle actin, desmin and myosin staining, and electron microscopy. Each specimen was assigned a "healing" score of 0 (normal) 1 (slight changes), 2 (mild changes), or 3 (severe changes). The fibrosis score was based on six factors: muscle layer fibrosis, lamina propria fibrosis, amount of granulation tissue present, new deposits of collagen, fibrosis in the periureteral fat, and presence of myofibroblasts. The muscles were characterized with immunohistochemistry and electron microscopy. Results: At both 3 and 5 months, the urothelium was healed, and the lamina propria was healed with focal loss. By 3 months, smooth-muscle bundles bridged the defect, and by 5 months, the whole defect was covered. Smooth muscle cells were evident by electron microscopy by 3 months, and actin and myosin could be detected by immunohistochemistry. Desmin-positive cells accounted for 50% of the population at 3 months and 40% at 5 months. The regenerated smooth-muscle bundles were oriented in different directions and intermingled with fibrous tissue. They could be distinguished easily from normal ureter under the microscope. Conclusion: Verifiable, functional smooth-muscle bundles bridge the endopyelotomy defect by 3 months, as confirmed by immunohistochemistry staining and electron microscopy.

Original languageEnglish
Pages (from-to)982-988
Number of pages7
JournalJournal of Endourology
Volume18
Issue number10
DOIs
StatePublished - Dec 2004

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Smooth Muscle
Regeneration
Electron Microscopy
Swine
Staining and Labeling
Fibrosis
Immunohistochemistry
Desmin
Muscles
Actins
Mucous Membrane
Smooth Muscle Myosins
Urothelium
Sus scrofa
Myofibroblasts
Granulation Tissue
Hematoxylin
Myosins
Eosine Yellowish-(YS)
Ureter

ASJC Scopus subject areas

  • Urology

Cite this

Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy. / Rehman, Jamil; Ragab, Maged M.; Venkatesh, Ramakrishna; Sundaram, Chandru; Khan, S. Ali; Sukkarieh, Troy; Samadi, David; Chughtai, Bilal; White, Francis; Bostwick, David; Waltzer, Wayne.

In: Journal of Endourology, Vol. 18, No. 10, 12.2004, p. 982-988.

Research output: Contribution to journalArticle

Rehman, J, Ragab, MM, Venkatesh, R, Sundaram, C, Khan, SA, Sukkarieh, T, Samadi, D, Chughtai, B, White, F, Bostwick, D & Waltzer, W 2004, 'Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy', Journal of Endourology, vol. 18, no. 10, pp. 982-988. https://doi.org/10.1089/end.2004.18.982
Rehman, Jamil ; Ragab, Maged M. ; Venkatesh, Ramakrishna ; Sundaram, Chandru ; Khan, S. Ali ; Sukkarieh, Troy ; Samadi, David ; Chughtai, Bilal ; White, Francis ; Bostwick, David ; Waltzer, Wayne. / Smooth-muscle regeneration after electrosurgical endopyelotomy in a porcine model as confirmed by electron microscopy. In: Journal of Endourology. 2004 ; Vol. 18, No. 10. pp. 982-988.
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AU - Ragab, Maged M.

AU - Venkatesh, Ramakrishna

AU - Sundaram, Chandru

AU - Khan, S. Ali

AU - Sukkarieh, Troy

AU - Samadi, David

AU - Chughtai, Bilal

AU - White, Francis

AU - Bostwick, David

AU - Waltzer, Wayne

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N2 - Background and Purpose: Endopyelotomy is the preferred treatment for ureteropelvic junction (UPJ) obstruction because of its short operating time, limited morbidity, fast recovery, and reasonable efficacy. We used tissue and immunohistochemistry staining and electron microscopy to look at the muscle regeneration following an endopyelotomy incision in a porcine model. Materials and Methods: Bilateral electrosurgical endopyelotomy was performed in six domestic pigs with placement of 7F 20-cm Percuflex® double-J stents for up to 4 weeks, and urinary tracts were harvested at 3 or 5 months. Specimen evaluation included tissue staining with hematoxylin-eosin, Masson's trichrome, and Verhoeff's iodine and Van Gieson solution; histochemical staining for smooth-muscle actin, desmin and myosin staining, and electron microscopy. Each specimen was assigned a "healing" score of 0 (normal) 1 (slight changes), 2 (mild changes), or 3 (severe changes). The fibrosis score was based on six factors: muscle layer fibrosis, lamina propria fibrosis, amount of granulation tissue present, new deposits of collagen, fibrosis in the periureteral fat, and presence of myofibroblasts. The muscles were characterized with immunohistochemistry and electron microscopy. Results: At both 3 and 5 months, the urothelium was healed, and the lamina propria was healed with focal loss. By 3 months, smooth-muscle bundles bridged the defect, and by 5 months, the whole defect was covered. Smooth muscle cells were evident by electron microscopy by 3 months, and actin and myosin could be detected by immunohistochemistry. Desmin-positive cells accounted for 50% of the population at 3 months and 40% at 5 months. The regenerated smooth-muscle bundles were oriented in different directions and intermingled with fibrous tissue. They could be distinguished easily from normal ureter under the microscope. Conclusion: Verifiable, functional smooth-muscle bundles bridge the endopyelotomy defect by 3 months, as confirmed by immunohistochemistry staining and electron microscopy.

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