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

  • Mohammad Javad Mohseni Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Seyed Hossein Hosseini Sharifi Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Fahimeh Jafarnezhad-Ansariha Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Masoumeh Majidi Zolbin Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Ali Mirshah Valad Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Paria Alinia Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
  • Abdolmohammad Kajbafzadeh Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI). http://orcid.org/0000-0002-1973-3509
  • Hamid Arshadi Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI). http://orcid.org/0000-0001-8115-2951

Abstract

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).
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References

1. Caione P, Villa M, Capozza N, De Gennaro M, Rizzoni G. Predictive risk factors for chronic renal failure in primary high‐grade vesico‐ureteric reflux. BJU international. 2004;93(9):1309-12.
2. Lenaghan D, Whitaker JG, Jensen F, Stephens FD. The natural history of reflux and long-term effects of reflux on the kidney. The Journal of urology. 1976;115(6):728-30.
3. LÄCKGREN G, WÅHLIN N, SKÖLDENBERG E, STENBERG A. Long-term followup of children treated with dextranomer/hyaluronic acid copolymer for vesicoureteral reflux. The Journal of urology. 2001;166(5):1887-92.
4. Tschopp P, Wesley-James T, Spekkens A, Lohfeld L. Collagen injections for urinary stress incontinence in a small urban urology practice: time to failure analysis of 99 cases. The Journal of urology. 1999;162(3 Part 1):779-83.
5. Kajbafzadeh A-M, Tourchi A, Ebadi M. The outcome of initial endoscopic treatment in the management of concomitant vesicoureteral reflux and ureteropelvic junction obstruction. Urology. 2013;81(5):1040-6.
6. PANNEK J, Brands FH, Senge T. Particle migration after transurethral injection of carbon coated beads for stress urinary incontinence. The Journal of urology. 2001;166(4):1350-3.
7. Antonopoulos IM, Piovesan AC, Falci Jr R, Kanashiro H, Saito FJ, Nahas WC. Transurethral injection therapy with carbon‐coated beads (Durasphere®) for treatment of recurrent pyelonephritis in kidney transplant patients with vesico‐ureteral reflux to the allograft. Clinical transplantation. 2011;25(2):329-33.
8. O'Donnell B, Puri P. Treatment of vesicoureteric reflux by endoscopic injection of Teflon. Br Med J (Clin Res Ed). 1984;289(6436):7-9.
9. Cloutier J, Blais A-S, Moore K, Bolduc S. Prospective study using a new bulking agent for the treatment of vesicoureteral reflux: polyacrylamide hydrogel. The Journal of urology. 2013;190(3):1034-7.
10. Oswald J, Riccabona M, Lusuardi L, Bartsch G, Radmayr C. Prospective comparison and 1-year follow-up of a single endoscopic subureteral polydimethylsiloxane versus dextranomer/hyaluronic acid copolymer injection for treatment of vesicoureteral reflux in children. Urology. 2002;60(5):894-7.
11. Van Capelle JW, Haan Td, Sayed WE, Azmy A. The long‐term outcome of the endoscopic subureteric implantation of polydimethylsiloxane for treating vesico‐ureteric reflux in children: a retrospective analysis of the first 195 consecutive patients in two European centres. BJU international. 2004;94(9):1348-51.
12. Zaccara A, Castagnetti M, Beniamin F, Rigamonti W. Late onset ureteric obstruction after endoscopic subureteric injection of calcium hydroxyapatite for primary vesicoureteric reflux. Urology. 2007;70(4):811. e1-. e3.
13. Kajbafzadeh A-M, Habibi Z, Tajik P. Endoscopic subureteral urocol injection for the treatment of vesicoureteral reflux. The Journal of urology. 2006;175(4):1480-4.
14. Kirsch AJ, Arlen AM, Lackgren G. Current trends in dextranomer hyaluronic acid copolymer (Deflux) injection technique for endoscopic treatment of vesicoureteral reflux. Urology. 2014;84(2):462-8.
15. Apolikhina I, Saidova A. Clinical effectiveness of bulking agent hyaluronic acid/dextranomer (Urodex). Geburtshilfe und Frauenheilkunde. 2011;71(10):A44.
16. Alizadeh F, Omidi I, Haghdani S, Khorrami MH, Izadpanahi MH, Sichani MM. A comparison between dextranomer/hyaluronic acid and polyacrylate polyalcohol copolymer as bulking agents for treating primary vesicoureteral reflux. Urology journal. 2019;16(2):174-9.
17. Reb P. Compositions and methods using microspheres and non-ionic contrast agents. Google Patents; 2019.
18. Atala A, Kim W, Paige KT, Vacanti CA, Retik AB. Endoscopic treatment of vesicoureteral reflux with a chondrocyte-alginate suspension. The Journal of urology. 1994;152(2):641-3.
19. Kajbafzadeh A-M, Aryan Z, Tourchi A, Alizadeh H. Long-term ultrasound appearance of concomitant autologous blood and dextranomer/hyaluronic acid copolymer implants: is it associated with successful correction of vesicoureteral reflux? Urology. 2013;81(2):407-13.
20. Kajbafzadeh A-M, Tourchi A, Mousavian A-A, Rouhi L, Tavangar SM, Sabetkish N. Bladder muscular wall regeneration with autologous adipose mesenchymal stem cells on three-dimensional collagen-based tissue-engineered prepuce and biocompatible nanofibrillar scaffold. Journal of pediatric urology. 2014;10(6):1051-8.
21. Aidun A, Safaei Firoozabady A, Teimoori M, Naseh E. Tissue Engineering in Lower Urinary Tract Reconstruction. Journal of Tissues and Materials. 2018;1(1):18-24.
22. Moradi L, Vasei M, Dehghan MM, Majidi M, Mohajeri SF, Bonakdar S. Regeneration of meniscus tissue using adipose mesenchymal stem cells-chondrocytes co-culture on a hybrid scaffold: in vivo study. Biomaterials. 2017;126:18-30.
23. Arlen AM, Kirsch AJ. Endoscopic Treatment of Vesicoureteral Reflux. Current Bladder Dysfunction Reports. 2017;12(3):217-24.
24. Matouschek E. Die Behandlung des vesikorenalen Refluxes durch tranurethrale Einspritzung von Teflonpaste. Urologe. 1981;20:263-4.
25. Arlen AM, Scherz HC, Kirsch AJ. Endoscopic injection techniques for vesicoureteral reflux. Pediatric Endourology Techniques: Springer; 2014. p. 207-16.
26. Kajbafzadeh A-M, Sabetkish S, Khorramirouz R, Sabetkish N. Comparison of histopathological characteristics of polyacrylate polyalcohol copolymer with dextranomer/hyaluronic acid after injection beneath the bladder mucosa layer: a rabbit model. International urology and nephrology. 2017;49(5):747-52.
27. Saba I, Ramsay S, Bolduc S, Orabi H. Stem Cell Therapy and Tissue Engineering in Urogenital Diseases. Advances in Stem Cell Therapy: Springer; 2017. p. 197-223.
28. Stenberg A, Lackgren G. A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. The Journal of urology. 1995;154(2):800-3.
29. Davis NF, Kheradmand F, Creagh T. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents. International urogynecology journal. 2013;24(6):913-9.
30. Guo J, Chen H, Wang Y, Cao C-B, Guan G-Q. A novel porcine acellular dermal matrix scaffold used in periodontal regeneration. International journal of oral science. 2013;5(1):37.
31. Lanier ST, Wang ED, Chen JJ, Arora BP, Katz SM, Gelfand MA, et al. The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction. Annals of plastic surgery. 2010;64(5):674-8.
32. De Moya MA, Dunham M, Inaba K, Bahouth H, Alam HB, Sultan B, et al. Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. Journal of Trauma and Acute Care Surgery. 2008;65(2):349-53.
Published
2021-06-26
How to Cite
MOHSENI, Mohammad Javad et al. Comparing the Endoscopic Sub Ureteral Injection of Lyophilized/Micronized Decellular Prepuce with Urodex: Histological Findings. Journal of Contemporary Medical Sciences, [S.l.], v. 7, n. 3, p. 183-188, june 2021. ISSN 2413-0516. Available at: <http://www.jocms.org/index.php/jcms/article/view/1006>. Date accessed: 21 jan. 2022. doi: https://doi.org/10.22317/jcms.v7i3.1006.
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