Use of epidermal growth factor and collagen synthesis inhibition as adjuvant to healing of ureteroureteral anastomosis.

Abstract

When treating a ureteral narrowing by endopyelotomy or endoureterotomy, the urologist hopes that after the narrowed area is cut, it will heal with a patent lumen. A ureteral stent is usually left in place to provide a framework for healing. In cases of failure, histologic examination shows a predominance of collagen. We evaluated the effects of epidermal growth factor (EGF) and a collagen synthesis inhibitor, halofuginone, as adjuncts to ureteral healing. Ten female pigs underwent ureteroureteral anastomosis bilaterally, with the left side being stented. They were then randomized to receive EGF (N = 4), halofunginone (N = 3), or saline (control; N = 3). On postoperative day 30, the ureters were examined grossly and histologically. The lumens of the ureters were significantly larger in the animals that received either EGF or funginone than in the control animals. The epithelium was significantly thicker in the animals that received halofunginone than in the controls or animals receiving EGF. The thickness of the smooth muscle and adventitia was similar in the three groups. Stenting improved the results. Both EGF and halofuginone show promise as adjuncts to endopyelotomy and endoureterotomy.