The smooth muscle ratio at the renal pelvis in adults: does it predict surgical outcome?
BACKGROUND
Patients with ureteropelvic junction obstruction occasionally remain undiagnosed until adulthood. There are no objective criteria to predict the results of pyeloplasty in adult patients. We have evaluated the results of pyeloplasty in adult patients and investigated whether these results are correlated with the histopathology of the surgical specimen.


METHODS
Histological sections from 26 patients with ureteropelvic junction obstruction were analyzed. Their mean age was 25.1 years. Diethylenetriamine-pentaacetic acid scans were used to determine the degree of renal obstruction and postoperative healing. Improvement in diuretic renography was defined as a greater than 20% decrease in the half-time of the preoperative value. To examine smooth muscle and collagen tissue, sections were stained using Masson's trichrome. Smooth muscle ratio was identified by color image analysis.


RESULTS
18 patients (69.2%) fulfilled the criteria of healing. Patients with an improved scan had a mean smooth muscle percent (SMP) of 1.85+/-0.87 while subjects with no significant change in their diuretic scans had a mean SMP of 0.36+/-0.03 (p=0.001). There was a strong correlation between the SMP and the improvement.


CONCLUSIONS
Adult pyeloplasty was found successful in about 70% of the cases. The SMP of the renal pelvis seems to be helpful in predicting the surgical outcome.
Senkul
Temucin
T
GATA Haydarpasa Training Hospital, Department of Urology, Uskudar/Istanbul, Turkey. temucinsenkul@superonline.com
Kucukodaci
Zafer
Z
Iseri
Cuneyt
C
Karademir
Kenan
K
Erden
Dogan
D
Baloglu
Huseyin
H
Narin
Yavuz
Y
D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000032:analysis; D004232:Diuretics; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology*; D004369:Pentetic Acid; D011237:Predictive Value of Tests; D011866:Radioisotope Renography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis* / Q000601:surgery; D013520:Urologic Surgical Procedures; D014945:Wound Healing
D004232:Diuretics; D004369:Pentetic Acid; D003094:Collagen