Abstract
ABSTRACTPurpose:We assessed the efficacy and safety of a single injection of three bulking agents over the short- and long-term follow-ups in rabbits. Dermal and preputial matrices were compared with Deflux (DxHA) injection.Material and methods:Twenty-four rabbits were divided into three groups. Group I (n=8) underwent the injection of a lyophilized dermal matrix (LDM) beneath the seromuscular layer of the bladder wall. Rabbits in group II (n=8) were injected with lyophilized preputial matrix (LPM). Rabbits of group III (n=8) were injected with DxHA as the control group. They were followed up for 1 and 6 months after the injection. Subcutaneous injection of all bulking agents was also performed in nude mice. Biopsies were stained with LCA (leukocyte common antibody), CD68, CD31, and CD34. Scanning electron microscopy (SEM) and MTT assay were also performed.Results:Immunohistochemistry staining with CD68 and LCA revealed higher inflammation grade in LDM as compared with LPM and DxHA. Fibrosis grade was also higher in LDM both in short- and long-term follow-ups. However, no significant difference was detected in CD31 and CD34 staining between control and experimental groups. SEM analysis showed that the particle size of LPM was more similar to DxHA. MTT assay revealed that cell proliferation was similar in DxHA, LDM, and LPM. In-vivo assay in nude mice model showed more promising results in LPM as compared with LDM.Conclusion:The long-term results demonstrated that LPM was more similar to Deflux with the least local tissue reaction, inflammation, and fibrosis grade.
Highlights
Bulking agents are widely used in the treatment of stress urinary incontinence and primary vesicoureteral reflux (VUR), as minimally invasive procedures
The DNA content was significantly decreased in the decellularized dermal matrix (0.38±0.14ng DNA/mg tissue) compared to native tissue (85.76±21.12ng/mg wet dermal tissue)
Larger particles with heterogeneous shapes were detected in lyophilized dermal matrix (LDM) as compared with DxHA as the gold standard bulking agent
Summary
Bulking agents are widely used in the treatment of stress urinary incontinence and primary vesicoureteral reflux (VUR), as minimally invasive procedures. The management of patients with VUR has been revolutionized with the endoscopic injection of bulking agents which is a simple, less time-consuming, and high-resolution rate technique. A variety of materials have been applied as a bulking agent since 1938, when the injection of sodium morrhuate around the urethra was first reported [1]. An ideal injectable bulking agent would have several characteristics including safety, hypoallergenic, non-immunogenic, well tolerance, biocompatibility, effectiveness, durability, and easy to administer. Minimal fibrotic in-growth and inflammatory response, acceptable wound healing, and retention of the bulking effect for prolonged periods are among other important characteristics for an applicable bulking agent [3]
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Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
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