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Endoscopic treatment of vesicoureteral reflux using calcium hydroxyl apatite in dogs.

Bakhtiari J, Kajbafzadeh AM, Marjani M, Veshkini A, Tavakoli A, Gharagozlou MJ, Niasari-Naslaji A - BMC Res Notes (2011)

Bottom Line: In control sides, radiographs confirmed the same grade of VUR, found at the initiation of the study.Therefore, the total success rate of this study was 91.67% (11/12).Histological findings confirmed inflammation at treated side.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir.

ABSTRACT

Background: Injection of biomaterial to suburetral region, using minimally invasive procedure, has become an interesting topic for urologists to treat vesicoureteral reflux. The objective of this study was to evaluate the feasibility of injecting newly introduced calcium hydroxyl apatite to suburetral region, for treating an experimentally induced vesicoureteral reflux in dogs.

Findings: Bilateral vesicoureteral refluxed (VUR) mixed breed dogs (n = 12; 10-15 kg live weight, 3-6 months of age) were selected for this study. The presence and grade of the reflux were determined using cystography. Accordingly, 6 dogs displayed grade 1 & 2 and the other 6 showed grade 3 & 4 bilateral VUR. Every single dog, with bilateral VUR, underwent endoscopic treatment and received an injection of calcium hydroxyl apatite (an Iranian made product) into the left (treated side) and an injection of the similar volume of normal saline in to the right (control side) subureteric space. One week, 3 and 6 months after treatment, cystography was performed. On each occasion, 4 dogs were euthanized by gas inhalation and biopsy samples were collected for histopathological study from ureter, bladder, kidney, lung and spleen in order to investigate the biomaterial migration into different organs. Data were analyzed using Chi-squared test. In control sides, radiographs confirmed the same grade of VUR, found at the initiation of the study. VUR was resolved in 100% (6/6) of Grade 1 & 2 and 83.33% (5/6) of Grade 3 & 4 in treated side. Therefore, the total success rate of this study was 91.67% (11/12). Macroscopic examination of the vesicouretral region of the treated side revealed a firm and consistent biomaterial mass at the site of injection. Histological findings confirmed inflammation at treated side. In contrast, there was no tissue reaction on control side. There was no evidence for biomaterial migration in macroscopic and microscopic observations in this study.

Conclusion: In the present study, a new biocompatible material produced a firm, consist and sustainable biomaterial mass in the suburetral region for treating vesicouretral reflux without any evidence of biomaterial migration.

No MeSH data available.


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Cystogram showing induced bilateral reflux.
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Figure 1: Cystogram showing induced bilateral reflux.

Mentions: In order to induce reflux, the bladder was exposed extraperitoneally through midline incision, and the ureteral orifices were identified and catheterized with 3Fr ureteral stent and reflux was induced by slitting the anterior roof of both intramural ureters for 5-7 mm. The mucosa of ureter and bladder were sutured to each other with 3/0 nylon suture material. Then, the ureteral catheters were removed and bladder was closed with 3/0 absorbable suture material in a routine two layer manner [14,15]. One month after inducing reflux, cystography was carried out under light general anesthesia to confirm the vesicoureteal reflux. Meglumine compound was allowed to run into the bladder until complete distention of bladder achieved. X-ray was taken in lateral and ventrodorsal positions. One month after inducing reflux, endoscopic treatment was performed by calcium hydroxyl apatite (an Iranian made product; Figure 1). The presence and grade of the reflux were determined prior to endoscopy using cystography. Accordingly, dogs were classified to have Grade 1 (n = 3), Grade 2 (n = 3), Grade 3 (n = 3) and Grade 4 (n = 3) bilateral VUR.


Endoscopic treatment of vesicoureteral reflux using calcium hydroxyl apatite in dogs.

Bakhtiari J, Kajbafzadeh AM, Marjani M, Veshkini A, Tavakoli A, Gharagozlou MJ, Niasari-Naslaji A - BMC Res Notes (2011)

Cystogram showing induced bilateral reflux.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037325&req=5

Figure 1: Cystogram showing induced bilateral reflux.
Mentions: In order to induce reflux, the bladder was exposed extraperitoneally through midline incision, and the ureteral orifices were identified and catheterized with 3Fr ureteral stent and reflux was induced by slitting the anterior roof of both intramural ureters for 5-7 mm. The mucosa of ureter and bladder were sutured to each other with 3/0 nylon suture material. Then, the ureteral catheters were removed and bladder was closed with 3/0 absorbable suture material in a routine two layer manner [14,15]. One month after inducing reflux, cystography was carried out under light general anesthesia to confirm the vesicoureteal reflux. Meglumine compound was allowed to run into the bladder until complete distention of bladder achieved. X-ray was taken in lateral and ventrodorsal positions. One month after inducing reflux, endoscopic treatment was performed by calcium hydroxyl apatite (an Iranian made product; Figure 1). The presence and grade of the reflux were determined prior to endoscopy using cystography. Accordingly, dogs were classified to have Grade 1 (n = 3), Grade 2 (n = 3), Grade 3 (n = 3) and Grade 4 (n = 3) bilateral VUR.

Bottom Line: In control sides, radiographs confirmed the same grade of VUR, found at the initiation of the study.Therefore, the total success rate of this study was 91.67% (11/12).Histological findings confirmed inflammation at treated side.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir.

ABSTRACT

Background: Injection of biomaterial to suburetral region, using minimally invasive procedure, has become an interesting topic for urologists to treat vesicoureteral reflux. The objective of this study was to evaluate the feasibility of injecting newly introduced calcium hydroxyl apatite to suburetral region, for treating an experimentally induced vesicoureteral reflux in dogs.

Findings: Bilateral vesicoureteral refluxed (VUR) mixed breed dogs (n = 12; 10-15 kg live weight, 3-6 months of age) were selected for this study. The presence and grade of the reflux were determined using cystography. Accordingly, 6 dogs displayed grade 1 & 2 and the other 6 showed grade 3 & 4 bilateral VUR. Every single dog, with bilateral VUR, underwent endoscopic treatment and received an injection of calcium hydroxyl apatite (an Iranian made product) into the left (treated side) and an injection of the similar volume of normal saline in to the right (control side) subureteric space. One week, 3 and 6 months after treatment, cystography was performed. On each occasion, 4 dogs were euthanized by gas inhalation and biopsy samples were collected for histopathological study from ureter, bladder, kidney, lung and spleen in order to investigate the biomaterial migration into different organs. Data were analyzed using Chi-squared test. In control sides, radiographs confirmed the same grade of VUR, found at the initiation of the study. VUR was resolved in 100% (6/6) of Grade 1 & 2 and 83.33% (5/6) of Grade 3 & 4 in treated side. Therefore, the total success rate of this study was 91.67% (11/12). Macroscopic examination of the vesicouretral region of the treated side revealed a firm and consistent biomaterial mass at the site of injection. Histological findings confirmed inflammation at treated side. In contrast, there was no tissue reaction on control side. There was no evidence for biomaterial migration in macroscopic and microscopic observations in this study.

Conclusion: In the present study, a new biocompatible material produced a firm, consist and sustainable biomaterial mass in the suburetral region for treating vesicouretral reflux without any evidence of biomaterial migration.

No MeSH data available.


Related in: MedlinePlus