Histopathologic changes at Intrinsic ureteral pelvic junction (UPB) stenosis and its effects on surgical results

The etiopathogenesis of introduction: intrinsic ureteral pelvic junction (UPB) stenosis is stil failed to be lightened. The real cause for UPB obstruction is; even if it is investigated in terms of embryological, anatomical, functional and histological terms is still is not clear. In this study our objective is to make a relation in the framework of an evidence-based medicine practices of intrinsic UPB stenosis, the underlying basic histopathologic reasons, the associated various parameters (collagen, Elastin, smooth muscle cell density, Cajal cells) working together with each other, their rates to each other, finding their decrease or increasing amounts and to associate it with results of surgical treatment.Material-METHODS: 66 UPB segment was included in the study and divided into 3 groups. Group 1 existed of 10 UPB segments with normal UPB to which nephrectomy was made for various reasons. Group 2 existed of 4 UPB segments which have suffered chronic obstruction due to stones and therefore has been made nephrectomy. Group 3 existed of 52 UPB segments which due to UPB stenosis was made dismembered pyeloplasty. In these groups we have analyzed differences in the number of Cajal cells, Elastin, collagen 3 amounts and fibrosis.Facts in Group 3 were also evaluated in two separate subjects. In the first evaluation, these segments with 52 intrinsic UPB stenosis were reviewed according to age groups and we have looked for differences between the pediatric age group and the adult age group belonging to the segments between UPB in terms of Cajal cells, Elastin, collagen 3 amounts and fibrosis.In the second evaluation we have compared 5 cases at patients with UPB stenosis whose dismembered pyeloplasty surgery operation as a result has failed with 42 successful cases in terms of surgery.Between the groups of unsuccessful and successful surgery we have looked for differences between the number of Cajal cells, Elastin, collagen 3 and fibrosis.RESULTS: At segments of patients with intrinsic UPB stenosis (n: 52), compared with normal groups (n 10 and n: 4) in terms of Cajal cells, Elastin, collagen 3 content and fibrosis no statistically significant increase or decrease of pathological evidence was found.Between UPB segments of pediatric age group (n: 10) and adult age (n: 42) in terms of Cajal cells, Elastin, collagen 3 content and fibrosis no statistically significant difference was found. At analysis performed between successful surgery (n: 47) and surgical failure (n: 5) in terms of Cajal cells, Elastin, collagen 3 and fibrosis also no significant difference was found.CONCLUSION: In the results of our study for segments with UPB stenosis in terms of Cajal cells, Elastin, collagen 3 between groups with normal UPB segments no significant difference was found.To put forward the basic histopathologic causes of UPB stenosis it is obvious that in larger series and more hard work is necessary.