Innervation of narrowed segment of upper ureter in children with ureteropelvic junction obstruction: Krakós M, Kobos J, Andrzejewska E. Urol Pol 2004(4);57:71-76

Abstract

Obstruction of the ureteropelvic junction is a common cause of hydronephrosis in children and adolescents. The authors evaluated innervation of the obstructed ureteropelvic junction segment resected during reconstructive surgery in 50 children with hydronephrosis, aged 3 to 12 years. The nerve structures were identified (in number) immunohistochemically with the use of antibodies anti PGP 9.5 (protein gene product) and NGF-R (nerve growth factor receptor). The study revealed much worse innervation (P<0.001) of obstructed segments of ureters compared to normal ureters of children after nephrectomies from other causes (trauma, neoplasms). Significant differences in number and distribution of nerve structures in the muscular layer of the ureteral wall were observed within the obstructed segment group. Innervation of the ureteral wall was found to be less evident in older children (aged 8-12 yrs) compared to younger children (aged 3-7 yrs) (P<0.001). The results support the thesis that the autonomic nervous system controls ureteral peristalsis and urine transport from renal pelvis to bladder. However, it remains unresolved as to whether the observed changes represent the cause or are simply a consequence of obstruction.