Abstract
To investigate the short and long term histopathological alterations caused by submucosal injection of dextranomers in sodium hyaluronan (DiHA) based on an experimental rat model. Sixty Sprague–Dawley rats were assigned into two groups as group I and II, each containing 30 rats. Totally 0.1 ml of saline solution and 0.1 ml of DiHA were injected into the submucosa of bladder of first (control) and second groups, respectively. Both group I and II were further subdivided into three other groups as Group IA, IB, IC and Group IIA, IIB, IIC according to the sacrificial period. Group IA and IIA, IB and IIB, IC and IIC rats (ten rats for each group) were sacrificed 3, 6, and 12 months after surgical procedure, respectively. Two slides prepared from injection site of the bladder were evaluated completely for each rat by being unaware of the groups and at random by two independent senior pathologists to determine the fibroblast invasion, collagen formation, capillary growth and inflammatory reaction. Additionally, randomized brain sections from each rat were also examined to detect migration of the injection material. The measurements were made using an ocular micrometer at 10× magnification. The results were assessed using t-tests for paired and independent samples, with P < 0.05 considered to indicate significant differences; all values were presented as the mean (SD). Migration to the brain was not detected in any group. Significant histopathological changes in the DiHA injected groups were granuloma formation in 43.3%, foreign body type giant cells in 76.6%, inflammatory infiltration in 100%, and fibroblasts surrounding microspheres in 100% of the rat bladder. The interaction between granuloma formation and long-term tissue effects in children is still obscure. We emphasize that further prospective human (and/or animal) studies are required to clarify the long-term effects of granuloma formation with regard to clinical applications.
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References
O’Donnell B, Puri P (1986) Endoscopic correction of primary vesicoureteric reflux. Br J Urol 58:601–604
Frey P, Jenny P, Herzog B (1991) Endoscopic subureteric collagen injection (SCIN): A new alternative treatment of vesicoureteric reflux in children. Experience in 82 refluxing ureters. Pediatr Surg Int 6:287–294
Lipsky H (1991) Endoscopic treatment of vesicouretic reflux with collagen. Pediatr Surg Int 6:301–303
Frey P, Berger D, Jenny P, Herzog B (1992) Subureteral collagen injection for the endoscopic treatment of vesicoureteral reflux in children. Follow up study of 97 treated ureters and histological analysis of collagen implants. J Urol 148:718–723
Vereecken RL, Proesmans W (1995) Results of endoscopic treatment for vesico-ureteric reflux. Eur Urol 27(1):76–79
Stenberg A, Lackgren G (1995) A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol 154:800–803
Reunanen M (1995) Correction of vesicoureteral reflux in children by endoscopic collagen injection: a prospective study. J Urol 154(6):2156–2158
Frey P, Lutz N, Jenny P, Herzog B (1995) Endoscopic subureteral collagen injection for the treatment of vesicoureteral reflux in infants and children. J Urol 154(2 Pt 2):804–807
Frey P, Gudinchet F, Jenny P (1997) Gax 65: a new injectable cross-linked collagen for the endoscopic treatment of vesicoureteral reflux a—double blind study evaluating its efficiency in children. J Urol 158(3):1210–1212
Ortenberg J (1998) Endoscopic treatment of vesicoureteral reflux in children. Urol Clin North Am 25(1):151–156
Lackgren G, Wahlin N, Stenberg A (1999) Endoscopic treatment of children with vesico-ureteric reflux. Acta Paediatr Suppl 431:62–71
Capozza N, Patricolo M, Lais A, Matarazzo E, Cainone P (2001) Endoscopic treatment of vesicoureteral reflux: twelve years’ experience. Urol Int 67(3):228–231
Herz D, Hafez A, Baglı D, Capolicchio G, McLorie G, Khoury A (2001) Efficacy of endoscopic subureteral polydimethylsiloxane injection for treatment of vesicoureteral reflux in children: a North American clinical report. J Urol 166(5):1880–1886
Lackgren G, Wahlin N, Skoldenberg E, Stenberg A (2001) Long-term follow up of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. J Urol 166(5):1887–1892
Chertin B, Colhoun E, Velayudham M, Puri P (2002) Endoscopic treatment of vesicoureteral reflux: 11–17 years of follow up. J Urol 167:1443–1446
Al-Hunayan AA, Kehinde EO, Elsalam MA, Al-Mukhtar RS (2002) Outcome of endoscopic treatment for vesicoureteral reflux in children using polydimehysiloxane. J Urol 168:2181–2183
Chertin B, De Caluwe D, Puri P (2003) Endoscopic treatment of primary grades IV and V vesicoureteral reflux in children with subureteral injection of polytetrafluoroethylene. J Urol 169(5):1847–1849
Kirsch AJ, Perez-Brayfield MR, Scherz HC (2003) Minimally invasive treatment of vesicoureteral reflux with endoscopic injection of dextranomer/hyaluronic acid copolymer: the children’s hospitals of Atlanta experience. J Urol 170(1):211–215
Puri P, Chertin B, Velayudham M, Dass L, Colhoun E (2003) Treatment of vesicoureteral reflux by endoscopic injection of dextranomer/hyaluronic acid copolymer: preliminary results. J Urol 170(4, Part 2 of 2):1541–1544
Matouschek E (1981) Die Behandlung des vesikorenalen refluxes durch transurethrale Einspritzung von teflonpaste. Der Urologe Ausg A 20:263–264
Mittleman RE, Marraccini JV (1983) Pulmonary teflon granulomas following periurethral teflon injection for urinary incontinence. Arch Pathol Lab Med 107:611–612
Malizia AA Jr, Reiman HM, Myers RP, Sande JR, Barham SS, Benson RC Jr. Dewanjee MK, Utz WJ (1984) Migration and granulomatous reaction after periurethral injection of polytef (Teflon). JAMA 251:3277–3281
Aaronson IA, Rames RA, Greene WB, Walsh LG, Hasal UA, Garen PD (1993) Endoscopic treatment of reflux: migration of teflon to the lungs and brain. Eur Urol 23:394–399
Smith DP, Kaplan WE, Oyasu R (1994) Evaluation of polydimethylsiloxane as an alternative in the endoscopic treatment of vesicoureteral reflux. J Urol 152: 1221–1224
Travis WD, Balogh K, Abraham JL (1985) Silicone granulomas: report of three cases and review of the literature. Hum Pathol 16:19–27
Hatanaka S, Oneda S, Okazaki K, Shong LJ, Yoshida A, Isaka H, Yoshida H (1993) Induction of malignant fibrous histiocytoma in female Fisher rats by implantation of cyanoacrylate, zirconia; polyvinyl chloride, or silicone. In Vivo 7:111–115
Dewan PA, Byard RW (1992) Is injected polytetrafluoroethylene (polytef) carcinogenic? Br J Urol 69:29–33
Frey P, Lutz N, Berger D, Herzog B (1994) Histological behaviour of gluteraldehyde cross-linked bovine collagen injected into the human bladder for the treatment of vesicoureteral reflux. J Urol 152:632–635
Leonard MP, Canning DA, Epstein JI, Gearhart JP, Jeffs RD (1990) Local tissue reaction to the subureteral injection of glutaraldehyde cross-linked bovine collagen in humans. J Urol 143:1209–1212
Frey P, Curschellas E, Kaeslin M (1991) Long-term histological results following glutaraldehyde cross-linked collagen injection into the suburothelial space of the mini-pig bladder. Pediatr Surg Int 6:252–260
Kempter F, Möhring K, Bersch W (1991) Results of endoscopic subureteral collagen injection for reflux correction in pigs and dogs. Pediatr Surg Int 6:261–268
Ringert RH, Mlynek ML, Zöllner G (1991) Reaction to intramural collagen implantation in rabbit bladder. Pediatr Surg Int 6:263–265
Vandenbossche M, Delhove O, Dumortier P (1993) Endoscopic treatment of reflux: Experimental study and review of teflon and collagen. Eur Urol 23:386–393
Frey P, Mangold S (1995) Physical and histological behavior of a new injectable collagen (Gax 65) implanted into submucosal space of the mini-pig bladder. J Urol 154(2):812–815
Stenberg A, Larsson E, Lackgren G (2003) Endoscopic treatment with dextranomer-hyaluronic acid for vesicoureteral reflux: histological findings. J Urol 169(3):1109–1113
Stenberg AM, Sundin A, Larsson BS, Lackgren G, Stenberg A (1997) Lack of distant migration after injection of a 125Iodine labeled dextranomer based implant into the rabbit bladder. J Urol 158:1937–1941
Stenberg A, Larsson E, Lindholm A, Ronneus B, Stenberg A, Lackgren G (1999) Injectable Dextranomer-based implant: histopathology, volume changes and DNA-analysis. Scand J Urol Nephrol 33:355–361
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Alkan, M., Ciftci, A.O., Talim, B. et al. Histological response to injected dextranomer-based implant in a rat model. Pediatr Surg Int 23, 183–187 (2007). https://doi.org/10.1007/s00383-006-1818-1
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DOI: https://doi.org/10.1007/s00383-006-1818-1