Ureteral Injection Research Articles

Ureteral identification with indocyanine green in laparoscopic colorectal surgery.

Fluorescence-guided surgery has emerged as a complement of traditional laparoscopic surgery with the advantage that is adaptable to existent platforms. The purpose of this article is to describe our technique for ureteral identification with indocyanine green (ICG) during laparoscopic colorectal surgery. We report a case series of all patients who underwent laparoscopic colorectal surgery and ureteral injection of ICG in a private third level hospital. We performed 30 laparoscopic colorectal surgeries in which we used this technique to identify the ureters. Mean age was 52.6 ± 15.28 years; 16 (53.3%) were men. The indication for surgery was diverticulitis in 18 patients. Mean urological operative time was 22.4minutes. There were no immediate or delayed adverse effects attributable to intra-ureteral ICG administration. Although ureteric iatrogenic injury is uncommon, when it does happen, it significantly increases the patient's morbidity. We consider this technique has the potential to make laparoscopic surgeries safer mostly in patients with cancer, diverticular disease or endometriosis who have extensive fibrosis, adhesions, and inflammation.

Comparing the Endoscopic Sub Ureteral Injection of Lyophilized/Micronized Decellular Prepuce with Urodex: Histological Findings

Objectives: In the present study, a new engineered bulking agent called lyophilized micronized prepuce was examined as a natural scaffold to compare its safety and efficacy with the Urodex®. Methods: For an in vivo study, 12 rabbits were divided into two groups. In the first group (n = 6), 0.2 cc of lyophilized and micronized prepuce, and in the second group, 0.2 cc of Urodex® was injected into the seromuscular wall of the bladder. The biopsy was provided from all animals for histological evaluation in 3 and 6 months’ post-surgery and for each timeline 12 animals were assigned. The biopsies were stained with H&E and trichrome Masson. IHC staining was also performed with anti-LCA+, anti-CD34+, and anti-CD68+ antibodies. Resluts: Microscopic examination of acellular prepuce compared with normal tissue demonstrated the success of this process, and ECM and collagen fibers were preserved with no evidence of cellular remnants in the acellular tissue, Immunohistochemistry staining with CD68 and LCA revealed a higher inflammation grade in Urodex as compared with Prepuce. However, no significant difference was detected in CD34 staining between Prepuce and Urodex experimental groups SEM analysis detected the micronized particle size varying between 2-5 µm. MTT assay revealed that cell proliferation was similar in the presence of control group and acellular prepuce. Conclusion: The results of this study disclosed that lyophilized and micronized prepuce could be an operative alternative to Urodex® as a natural and non-synthetic bulking agent in the treatment of children with vesicoureteral reflux (VUR).

The Efficiency and Safety of Endoscopic Treatment on Kidney-Transplanted Patients With Symptomatic Vesicoureteral Reflux in Native and Transplanted Renal Units

ObjectivesTo evaluate the outcome of endoscopic treatment of symptomatic vesicoureteral reflux (VUR) in patients with VUR in both transplanted and native renal units. Material and MethodsBetween January 2014 and December 2019, 23 transplanted patients with symptomatic VUR with reflux in both transplanted and native kidney were included in the study. All patients were patients with a history of kidney failure due to reflux nephropathy. A voiding cystourethrography was performed after at least 1 episode of acute glomerulo pyelonephritis or deterioration of the graft function. All patients underwent a urine culture and an ultrasonic evaluation preoperatively. A dextranomer/hyaluronic acid bulking agent was injected via endoscope by a rigid metal needle around a double J stent. Clinical success was defined as absent of febrile urinary tract infection during the follow-up period. ResultsThe procedure was applied in 52 effected renal units; of these, 27 were transplanted kidneys, and 25 were native kidneys. Overall clinical success was achieved in 69.6% (N = 16) of patients. The success rate after the first procedure was 52.2% (N = 12), whereas 17.3% (N = 4) achieved success after the second treatment. No intraoperative complications occurred throughout the endoscopic procedure. Minor postoperative complications included 2 (10%) cases of self-limiting episodes of hematuria that did not require intervention. ConclusionEndoscopic treatment of symptomatic VUR for both transplanted ureter and native ureter is a safe treatment in most of the patients. Therefore, endoscopic ureteral injection is a treatment modality with low morbidity that should be preferred to open surgery as first-line treatment in this subgroup of patients.

Effects of Tissue Pressure on Transgene Expression Characteristics via Renal Local Administration Routes from Ureter or Renal Artery in the Rat Kidney

We previously developed a renal pressure-mediated transfection method (renal pressure method) as a kidney-specific in vivo gene delivery system. However, additional information on selecting other injection routes and applicable animals remains unclear. In this study, we selected renal arterial and ureteral injections as local administration routes and evaluated the characteristics of gene delivery such as efficacy, safety, and distribution in pressured kidney of rat. Immediately after the naked pDNA injection, via renal artery or ureter, the left kidney of the rat was pressured using a pressure controlling device. Transfection efficiency of the pressured kidney was about 100-fold higher than that of the injection only group in both administration routes. The optimal pressure intensity in the rat kidney was 1.2 N/cm2 for renal arterial injection and 0.9 N/cm2 for ureteral injection. We found that transgene expression site differs according to administration route: cortical fibroblasts and renal tubule in renal arterial injection and cortical and medullary tubule and medullary collecting duct in ureteral injection. This is the first report to demonstrate that the renal pressure method can also be effective, after renal arterial and ureteral injections, in rat kidney.

Novel Approaches to Manipulate Gene Expression in the Mouse Kidney: siRNA Silencing and Gene Rescue

Essential hypertension represents a multifactorial set of genetic dysfunctions that involve several organ systems, including the kidney. The mechanistic underpinnings of hypertension has been facilitated by the availability of knockout mouse models, which allow the functional analysis of specific genes involved in the regulation of blood pressure (BP) and ion transport. Recent innovations on knockout mouse models, e.g., conditional knockouts, allow the reversible silencing of genes in a limited number of tissues; however, this technology is tedious, expensive and not always successful. Moreover, the use of gene complementation techniques has been instrumental in confirming the function of genes of interest in vivo. Therefore, we evaluated the feasibility and efficiency of using two complementary techniques to study gene function in mice, namely, the (1) delivery of gene‐specific siRNA via an osmotic pump into the renal parenchyma, and (2) bolus retrograde injection of the gene of interest packaged in AAV9 viral vectors into the ureter of the kidney. Previously uninephrectomized and acclimated mice were surgically implanted with an osmotic pump equipped with an attached 28G‐tipped polyurethane tube to infuse siRNA dissolved in an in vivo transfection reagent into the subcapsular space of the kidney. A 28‐day siRNA infusion (3μg/day) which ensured optimum silencing of the targeted gene neither resulted in gross or histological changes in the renal morphology nor spillage into other organ systems, i.e. the heart and liver. We silenced the renal Drd2 gene expression by ~65% in four C57Bl/6J mice which resulted in increased systolic blood pressure (DSBP=21±4.5 mm Hg vs. 1.0±2.9 mm Hg, measured via the femoral artery, in non‐silencing “mock” siRNA‐treated mice), similar to the hypertension observed in Drd2 knockout mice; Drd2 encodes for the dopamine receptor type 2, D2R, whose absence results in hypertension. When a siRNA against a gene (e.g., USP48 which prevents the degradation of NHE3) whose absence should decrease BP was tested, systolic BP was effectively decreased (DSBP=−21±2 mm Hg; n=5), suggesting that the resultant phenotype depends upon the specific gene being silenced. We next compared the effect of unilateral infusion of Drd2‐specific siRNA in mice with both kidneys intact. The BP was unchanged after a 7‐day infusion, but increased after 28 days of infusion (DSBP=26±2 mm Hg; n=5), suggesting that the presence of the contralateral, non‐infused kidney could initially compensate for the loss of D2R but not in the long‐term. The unilateral renal infusion of siRNA did not change the D2R expression of the non‐infused kidney, regardless of the duration of infusion, demonstrating the feasibility to use one kidney as an internal control for the functional analysis of gene silencing in the targeted kidney. We next performed gene rescue experiments in C57Bl/6J mice that have been previously depleted of their renal D2R using a human Drd2 gene subcloned in a mammalian expression vector and packaged in an AAV9 viral vector. Fifteen days post‐silencing, a bolus of Drd2‐AAV9 was given via retrograde ureteral injection. The D2R expression increased 7.5‐fold (compared to control) and the blood pressure was normalized at 14 days post‐infusion; mock‐AAV9 had no effect n=3/group). Our novel strategies for gene silencing and gene rescue in mice may prove to be an easier and more versatile approach of genetic manipulation compared to traditional methods.Support or Funding InformationThe work was funded by grants from the US National Institutes of Health: P01HL074940, P01HL068686, R01HL092196, R37HL023081, R01DK039308, and DK090918.

Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: Guaranteed success?

ObjectiveThis study was designed to investigate whether post-endoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome. Patients and methodsPatients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR. ResultsOver a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months–11 years). Thirty-two renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications. ConclusionOf all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.

V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V377 TECHNIQUE OF ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR MULTIPLE RENAL LESIONS David Josephson, Chris Whelan, John Yamzon, Clayton Lau, Bertram Yuh, and Timothy Wilson David JosephsonDavid Josephson Duarte, CA More articles by this author , Chris WhelanChris Whelan Duarte, CA More articles by this author , John YamzonJohn Yamzon Duarte, CA More articles by this author , Clayton LauClayton Lau Duarte, CA More articles by this author , Bertram YuhBertram Yuh Duarte, CA More articles by this author , and Timothy WilsonTimothy Wilson Duarte, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.464AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We highlight the technical aspects of robotic assisted laparoscopic partial nephrectomy for multiple left renal masses on a patient with Von Hippel-Lindau syndrome (VHL). METHODS The patient is a 24 old female with bilateral renal masses, with 4 lesions on the right and 9 on the left, the largest being 3 cm. We approached this as a staged bilateral partial nephrectomy utilizing robotic assistance. Management of her left kidney proceeded as described. She is secured to the table in a left modified flank position. Following establishment of a pneumoperitoneum, a 12 mm midline camera port is placed followed by two lateral 8mm robotic ports. After the robot is docked, the operation commences with standard robotic techniques for renal dissection and exposure of the hilum. Next, the perirenal fat is mobilized with sharp dissection and monopolar cautery, exposing the renal capsule in its entirety. Laparoscopic ultrasound is used to confirm the location and depth of the tumors. The hilum is clamped and all lesions were sharply excised. Retrograde ureteral injection of methylene blue identifies a collecting system defect, which is closed with vicryl suture. Running renorrhaphy sutures through the capsule are used to close the renal defects. Hemostatic agents are placed followed by removal of the hilar bulldog clamps. Excised tumors are removed through a laparoscopic retrieval bag. RESULTS Procedure time was 240 minutes. Warm ischemia time was 34 minutes. Blood loss was 350 ml. The patient was discharged home on postoperative day 4 and recovered well. Creatinine was unchanged from baseline at 1.08. Final pathology shows 9 separate tumors, all clear cell carcinoma, grade 2. All permanent margins were negative. CONCLUSIONS Robotic assisted laparoscopic partial nephrectomy is safe and effective for management of multiple renal tumors in a single operative setting. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e153 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Josephson Duarte, CA More articles by this author Chris Whelan Duarte, CA More articles by this author John Yamzon Duarte, CA More articles by this author Clayton Lau Duarte, CA More articles by this author Bertram Yuh Duarte, CA More articles by this author Timothy Wilson Duarte, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transforming growth factor-beta1 antisense oligodeoxynucleotides block interstitial fibrosis in unilateral ureteral obstruction

Transforming growth factor-β1 antisense oligodeoxynucleotides block interstitial fibrosis in unilateral ureteral obstruction.BackgroundInterstitial expression of transforming growth factor-β1 (TGF-β1) is important in tubulointerstitial fibrosis, a common process in most progressive renal diseases. However, no effective therapy for progressive interstitial fibrosis is known. Recently, we developed an artificial viral envelope (AVE)-type hemagglutinating virus of Japan (HVJ) liposome-mediated retrograde ureteral gene transfer method, which allowed us to introduce the genetic material selectively into renal interstitial fibroblasts.MethodWe introduced antisense or scrambled oligodeoxynucleotides (ODNs) for TGF-β1 into interstitial fibroblasts in rats with unilateral ureteral obstruction, a model of interstitial fibrosis, to block interstitial fibrosis by retrograde ureteral injection of AVE-type HVJ liposomes.ResultsTGF-β1 and type I collagen mRNA increased markedly in the interstitium of untreated obstructed kidneys, and those were not affected by scrambled ODN transfection. Northern analysis and in situ hybridization revealed that the levels of TGF-β1 and type I collagen mRNA were dramatically decreased in antisense ODN-transfected obstructed kidneys. Consequently, the interstitial fibrotic area of the obstructed kidneys treated with antisense ODN was significantly less than that of the obstructed kidneys untreated or treated with scrambled ODN.ConclusionThe introduction of TGF-β1 antisense ODN into interstitial fibroblasts may be a potential therapeutic maneuver for interstitial fibrosis. Transforming growth factor-β1 antisense oligodeoxynucleotides block interstitial fibrosis in unilateral ureteral obstruction. Interstitial expression of transforming growth factor-β1 (TGF-β1) is important in tubulointerstitial fibrosis, a common process in most progressive renal diseases. However, no effective therapy for progressive interstitial fibrosis is known. Recently, we developed an artificial viral envelope (AVE)-type hemagglutinating virus of Japan (HVJ) liposome-mediated retrograde ureteral gene transfer method, which allowed us to introduce the genetic material selectively into renal interstitial fibroblasts. We introduced antisense or scrambled oligodeoxynucleotides (ODNs) for TGF-β1 into interstitial fibroblasts in rats with unilateral ureteral obstruction, a model of interstitial fibrosis, to block interstitial fibrosis by retrograde ureteral injection of AVE-type HVJ liposomes. TGF-β1 and type I collagen mRNA increased markedly in the interstitium of untreated obstructed kidneys, and those were not affected by scrambled ODN transfection. Northern analysis and in situ hybridization revealed that the levels of TGF-β1 and type I collagen mRNA were dramatically decreased in antisense ODN-transfected obstructed kidneys. Consequently, the interstitial fibrotic area of the obstructed kidneys treated with antisense ODN was significantly less than that of the obstructed kidneys untreated or treated with scrambled ODN. The introduction of TGF-β1 antisense ODN into interstitial fibroblasts may be a potential therapeutic maneuver for interstitial fibrosis.

Transforming growth factor-β1 antisense oligodeoxynucleotides block interstitial fibrosis in unilateral ureteral obstruction

Interstitial expression of transforming growth factor-beta1 (TGF-beta1) is important in tubulointerstitial fibrosis, a common process in most progressive renal diseases. However, no effective therapy for progressive interstitial fibrosis is known. Recently, we developed an artificial viral envelope (AVE)-type hemagglutinating virus of Japan (HVJ) liposome-mediated retrograde ureteral gene transfer method, which allowed us to introduce the genetic material selectively into renal interstitial fibroblasts. We introduced antisense or scrambled oligodeoxynucleotides (ODNs) for TGF-beta 1 into interstitial fibroblasts in rats with unilateral ureteral obstruction, a model of interstitial fibrosis, to block interstitial fibrosis by retrograde ureteral injection of AVE-type HVJ liposomes. TGF-beta 1 and type I collagen mRNA increased markedly in the interstitium of untreated obstructed kidneys, and those were not affected by scrambled ODN transfection. Northern analysis and in situ hybridization revealed that the levels of TGF-beta 1 and type I collagen mRNA were dramatically decreased in antisense ODN-transfected obstructed kidneys. Consequently, the interstitial fibrotic area of the obstructed kidneys treated with antisense ODN was significantly less than that of the obstructed kidneys untreated or treated with scrambled ODN. The introduction of TGF-beta 1 antisense ODN into interstitial fibroblasts may be a potential therapeutic maneuver for interstitial fibrosis.

Effect of glandular kallikrein on distal nephron HCO 3 − secretion in rats and on HCO 3 − secretion in MDCK cells

Renal kallikrein is localized in the connecting tubule cells and secreted into the tubular fluid at late distal nephron segments. The present experiments were performed to further test the hypothesis that renal kallikrein reduces bicarbonate secretion of cortical collecting duct (CCD). The effect of orthograde injections of pig pancreatic kallikrein (1 or 3 micrograms/ml) into the renal tubular system was investigated. Urine fractions (Fr) were collected after a 2-min stop flow. Changes in the urine fraction with respect to those in free-flow urine samples (Ff) were related to the respective polyfructosan (Inutest) ratio. Renal kallikrein activity (Fr:Ff kallikrein/ Fr:Ff polyfructosan) increased significantly in the first two urine fractions collected after glandular kallikrein administration (kallikrein, 1 microgram/ml, P < 0.05; kallikrein, 3 micrograms/ml, P < 0.01). HCO3- secretion of collecting ducts was significantly reduced dose dependently by orthograde and also reduced by retrograde pig pancreatic kallikrein administration. Release of kinins into the fractions was not affected by the retrograde kallikrein injection, even though the kallikrein activity increased considerably (2.26 +/- 0.2 vs. 1.55 +/- 0.2, P < 0.05). Adequacy of retrograde injections for delivering substances to the CCD was demonstrated by injecting colloidal mercury and detecting the appearance of this mercury in the renal cortex by transmission electron microscopy. The integrity of the renal tissue after a retrograde ureteral injection was confirmed by scanning electron microscopy. These results confirm and extend previous data (M. Marin-Grez and P. Vallés. Renal Physiol. Biochem. 17: 301-306, 1994; and M. Marin-Grez, P. Vallés, and P. Odigie. J. Physiol. 488: 163-170, 1995) showing that renal kallikrein reduces bicarbonate secretion at the CCD, probably by inhibiting HCO3- transported by a mechanism unrelated to its kininogenase activity. Support for this assessment was obtained in experiments testing the effect of kallikrein on the luminal bicarbonate secretion of a subpopulation of Madin-Darby canine kidney cells capable of extruding the anion. Kallikrein inhibited HCO3-/Cl- exchange, and the degree of inhibition was dose dependent. This inhibition occurred in the absence of kininogen in the bathing solution.

Microradiographic Studies of Renal Lymphatics

Cortical and medullary lymphatics have been observed during micro-angiographic studies of canine renal allograft rejection and retrograde ureteral injection in normal pigs. Lymphatic filling results from microvascular damage in the canine model and forniceal rupture in the pig. Renal lymphatics function as an alternate route for drainage during altered physiological states.