title: Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model.
abstract: To examine the effect of ureteral access sheath (UAS) on the expression of the pro-inflammatory mediators cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) in the ureteral wall.
  
  
  
  In 22 pigs an UAS was inserted and removed after 2 minutes on one side and 2 hours on the contralateral side. Postoperatively ureters were excised in vivo, and tissue samples from the distal (2 minutes/2 hours) and proximal ureter (2 minutes/2 hours) were snap-frozen before quantitative polymerase chain reaction analysis of COX-2 and TNF-α. Five unmanipulated ureteral units from other pigs served as the control group.
  
  
  
  Compared to controls COX-2 mRNA was significantly upregulated in all UAS treated ureteral groups. Similarly, TNF-α mRNA was upregulated in all groups except the 2-minute proximal ureteral group. Both COX-2 and TNF-α expression were significantly higher in the distal than in the proximal ureter in the UAS treated ureters. After UAS insertion for 2 minutes, expression levels in the distal ureter were increased 6.5- and 8-fold for COX-2 and TNF-α, respectively; and after 2 hours of UAS placement COX-2 and TNF-α mRNA expression levels were increased 9- and 9.5-fold, respectively.
  
  
  
  The pro-inflammatory mediators COX-2 and TNF-α were significantly upregulated in the ureteral wall by the influence of UAS. These findings may have implications for postoperative pain, drainage, and complications.
authors.affiliation: 1 Department of Urology, Urological Research Center, Lillebaelt Hospital , Vejle, Denmark .|2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .
authors.forename: Søren Kissow
authors.initials: SK
authors.lastname: Lildal
authors.affiliation: 3 Institute of Clinical Research, Aarhus University , Aarhus, Denmark .
authors.forename: Rikke
authors.initials: R
authors.lastname: Nørregaard
authors.affiliation: 1 Department of Urology, Urological Research Center, Lillebaelt Hospital , Vejle, Denmark .|2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .
authors.forename: Kim Hovgaard
authors.initials: KH
authors.lastname: Andreassen
authors.affiliation: 1 Department of Urology, Urological Research Center, Lillebaelt Hospital , Vejle, Denmark .|2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .
authors.forename: Frederikke Eichner
authors.initials: FE
authors.lastname: Christiansen
authors.affiliation: 1 Department of Urology, Urological Research Center, Lillebaelt Hospital , Vejle, Denmark .|2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .
authors.forename: Helene
authors.initials: H
authors.lastname: Jung
authors.affiliation: 2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .|4 Department of Radiology, Lillebaelt Hospital , Vejle, Denmark .
authors.forename: Malene Roland
authors.initials: MR
authors.lastname: Pedersen
authors.affiliation: 1 Department of Urology, Urological Research Center, Lillebaelt Hospital , Vejle, Denmark .|2 Institute of Regional Health Research, University of Southern Denmark , Vejle, Denmark .
authors.forename: Palle Jörn Sloth
authors.initials: PJ
authors.lastname: Osther
mesh_terms: D000818:Animals; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D004195:Disease Models, Animal; D008297:Male; D016133:Polymerase Chain Reaction; D034421:Sus scrofa; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D014513:Ureter / Q000378:metabolism* / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D051546:Cyclooxygenase 2
keywords: complications; cyclooxygenase-2; tumor necrosis factor-α; ureter; ureteral access sheath; ureteroscopy