Comparison Of The Cytokine Profiles And Ultrastructural Changes In The Ureterovesical Junctions Of Children With Primary Vesicoureteral Reflux And Children With Primary VUR Following Failed Injection Therapy With Dx/HA

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Purpose: To compare the cytokine profiles and ultrastructural changes in the ureterovesical junctions of children with primary vesicoureteral reflux(VUR) and children with primary VUR following failed injection therapy with dextranomer/hyaluronic-acid (Dx/HA) using immunohistochemical methods and transmission electron microscopy (TEM).Materials and Methods: 41 children underwent ureteroneocystostomy for VUR and 18 children underwent ureteroneocystostomy for primary VUR following failed injection therapy with Dx/HA.Sixty-seven distal intravesical ureters were obtained during surgery for histopathological and ultrastructural evaluations.The ureteral wall smooth-muscle organization and transforming growth factor-β1(TGF-β1), vascular endothelial growth factor(VEGF), and CD34 were evaluated immunohistochemically.The ultrastructural evaluations and morphological descriptions were performed semi-quantitatively.Results: Of the patients, 10(24,3%) were male and 31(75,7%) were female.28 ureter had a history of failed Dx/HA injections.Histopathology; the amount of TGF-β1, and the VEGF and CD34 levels were same in the patients with primary VUR and patients with primary VUR following failed injection therapy with Dx/HA but different compared with the control group(p=0.001,p<0.001,and p<0.001, respectively), but the differences were not correlated with the grade of reflux(p=0.42,p=0.26 and p=0.94 respectively).Ultrastructural changes in the muscle cells were observed in all the VUR specimens.Conclusions: Our study demonstrated that ultra-structural changes in the muscle cells were observed in all VUR specimens.There was no significant difference in the quantification of cytokine assays between the patients with primary VUR and primary VUR with failed Dx/HA therapy.The quantification of VEGF, CD34, and, TGF-β1 levels was comparable in both primary VUR groups.