title: Endopyelotomy failure is associated with reduced urinary transforming growth factor-beta1 levels in patients with upper urinary tract obstruction.
abstract: OBJECTIVE
  We previously demonstrated that obstructed ureteropelvic junction (UPJ) segments from patients who had secondary pyeloplasty after endopyelotomy failure expressed transforming growth factor-beta1 (TGF-beta1) at levels significantly lower than patients who had primary pyeloplasty. In order to determine whether these differences in secreted TGF-beta1 are detectable preoperatively in the urine, the TGF-beta1 concentration of urine from patients undergoing endopyelotomy was determined and compared with that from subjects without urologic disease.
  
  
  METHODS
  Bladder and renal pelvic urine from the obstructed side was obtained from patients (N = 34) undergoing primary endopyelotomy for UPJ obstruction. Bladder urine was also obtained from sex- and age-matched patients (N = 26) having no evidence of urinary tract obstruction. The TGF-beta1 concentration was determined by ELISA and normalized to the creatinine concentration.
  
  
  RESULTS
  The bladder urine TGF-beta1 concentration was significantly (P < 0.02) higher in patients with UPJ obstruction (86.1+/-20.5 pg/mg of creatinine) than in those without obstruction (29.7+/-8.0 pg/mg creatinine). The TGF-beta1 concentration in the bladder urine of patients who underwent endopyelotomy and later returned because of UPJ obstruction (25.7+/-12.3 pg/mg of creatinine; N = 6) was not significantly different from the value in unobstructed patients but was significantly lower (P < 0.01) than in patients for whom endopyelotomy was successful (100+/-24.29 pg/mg of creatinine; N = 28). The renal pelvic urinary TGF-beta1 concentration was higher in patients for whom endopyelotomy was successful (772+/-490.1 pg/mg of creatinine) than in patients who underwent endopyelotomy and later returned because of UPJ obstruction (126.1+/-41.9 pg/mg of creatinine).
  
  
  CONCLUSIONS
  These data suggest that preoperative concentration of TGF-beta1 in the bladder urine of patients with UPJ obstruction who fail endopyelotomy is not significantly different from that in subjects with no urologic disease and significantly lower than in those patients for whom endopyelotomy is successful. Thus, the preoperative bladder urine concentration of TGF-beta1 may assist in selecting patients for this operation, although further investigation is necessary.
authors.affiliation: Department of Urology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11042, USA.
authors.forename: E N
authors.initials: EN
authors.lastname: Liatsikos
authors.forename: C Z
authors.initials: CZ
authors.lastname: Dinlenc
authors.forename: N O
authors.initials: NO
authors.lastname: Bernardo
authors.forename: R
authors.initials: R
authors.lastname: Kapoor
authors.forename: M E
authors.initials: ME
authors.lastname: Jabbour
authors.forename: A D
authors.initials: AD
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Kushner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006801:Humans; D007682:Kidney Pelvis; D008875:Middle Aged; D009994:Osmolar Concentration; D016212:Transforming Growth Factor beta / Q000652:urine*; D053773:Transforming Growth Factor beta1; D017211:Treatment Failure; D014517:Ureteral Obstruction / Q000601:surgery* / Q000652:urine*
chemical_list: C508960:TGFB1 protein, human; D016212:Transforming Growth Factor beta; D053773:Transforming Growth Factor beta1