The analysis of interstitial cells of Cajal and smooth muscle fiber in the distal ureters affecting the postoperative reflux after cohen reimplantationin

Abstract

Objective To find out the alteration of the interstitial cells of Cajal (ICC) and smooth muscle fiber (SMF) in distal ureters of primary vesicoureteral reflux (VUR) and obstructive megaureter (POM), and whether ICC and SMF can influences on the postoperative reflux of Cohen. Methods The retrospective study was based on information retrieved from Beijing Children's Hospital from January 2001 to December 2013. All the patients were primary VUR and POM that underwent a primary operation of cross-trigonal intravesical reimplantation described by Cohen. Secondary vesicoureteral reflux and ureterovesical junction were excluded. The distal ureters of resected Wilms' tumor were assigned to control group (not invaded by tumor). We chose 20 cases of Wilms' tumor for control group, 30 cases each for VUR and POM groups from successful operation dates, the differences of SMF and ICC were analyzed in control, VUR and POM groups by Masson and c-kit immunohistochemical staining. All the failed operation patients were divided into VUR and POM groups. Statistical tests were used to detect the differences of SMF and ICC between successful and failed operation in VUR and POM groups. Results The data of 218 VUR and POM patients were available and recorded. We excluded one each in complications of contralateral reflux and vesicoureteral obstruction. Finally there were 216 cases in the research, with 74 cases in VUR and 142 cases in POM. Complications of reflux present in 19 patients (10 cases in VUR and 9 cases in POM). Ureteral length-to-diameter ratio of the submucosal tunnel was 2.5~7.0. Follow-up time was 6~53 months. The distribution ICC and SMF in the distal ureter were significant difference: the control group>POM group>VUR group. ICC did not affect the prognosis of Cohen reimplantation (P>0.05). Conclusions ICC and SMF proportion decreas in the VUR and POM in distal ureters. There are no factors that postively affected the postoperative reflux of Cohen.The ICC might not affect the postoperative reflux of Cohen reimplantation if the submucosal tunnel is long enough. Key words: Vesico-ureteral reflux; Primary obstructive megaureter; Smooth muscle cells