SMOOTH MUSCLE CELLS AND COLLAGEN FIBRES ARCHITECTURE IN EQUIVOCAL URETEROPELVIC JUNCTION OBSTRUCTION: ELECTRON MICROSCOPY STUDY WITH CLINICAL CORRELATION IN ADULT EGYPTIANS | ||||
Journal of the Egyptian Society of Parasitology | ||||
Article 30, Volume 50, Issue 2, August 2020, Page 453-458 PDF (921.41 K) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/jesp.2020.113117 | ||||
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Authors | ||||
MOHAMED WISHAHI1; AMR ELKHOLY1; MOHAMED H. BADAWY1; EHAB HAFIZ2; HOSSAM ELGANZOURY1; HANI H. NOUR1; MOHAMED A. ISMAIL1; AHMED S. ZAYED1; SAMIR ELDAHSHAN1; AHMED A. MEHENA1; TAREK EL-LEITHY1 | ||||
1Department of Urology | ||||
2Department of Pathology and Electron Microscopy | ||||
Abstract | ||||
Adult patients with ureteropelvic junction obstruction (UPJO) would undergo operative pyeloplasty or considered an equivocal type, the decision for management of equivocal UPJO whether pyeloplasty or watchful follow-up is debatable. Equivocal UPJO referred to findings and patient’ symptoms suggested an obstruction, whereas the diuretic renogram is not conclusive to have a decision of pyeloplasty. This study evaluated the smooth muscle arrangement, distribution of collagen fibers, and presence of fibrosis in the UPJ segment in equivocal UPJO and normal UPJ segments using transmission electron microscopy (TEM) methods. The study design consisted of 30 adult Egyptian patients who underwent pyeloplasty for unilateral equivocal UPJO. Ten adult patients who had been operated on for oncological indications constituted the control group. Ten representative specimens of UPJO and 5 representative specimens of the control group were examined by TEM. Clinical study comprised 30 patients having equivocal UPJO and operated upon with pyeloplasty were followed for 2 years. Retrospectively analyses of records of 42 adult patients who had unilateral equivocal UPJO and were on watchful followup < br />for 2 years was done to compare results of Pyeloplasty to watchful follow-up. Electron microscopy study of UPJ segment of equivocal UPJO and the normal control cases showed similar findings with proper arrangement of smooth muscle fibers that were in close contact to each other, without fibroblast imposed between muscle bundles, and few collagen fibers were found. Clinical evaluation of results of pyeloplasty or watchful follow-up in equivocal UOJO in adults showed stable radiological findings, stable split renal function and diuretic renogram. In the watchful follow-up group 12% of cases required pyeloplasty, indication for pyeloplasty were repeated urinary tract infection, intolerable recurrent pain. The clinical series supported by ultrastructure findings showed that watchful follow-up of equivocal UPJO was an accepted treatment option. | ||||
Keywords | ||||
Ureteropelvic junction obstruction; Hydronephrosis; Pyeloplasty; Ultrastructure | ||||
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