Evaluation of different pathological markers in predicting outcomes of pyeloplasty in children with uretero pelvic junction obstruction

Abstract

The primary aim is to evaluate the different pathological markers in predicting the outcome of pyeloplasty in children with uretero pelvic junction obstruction The secondary aims are to develop a frozen section technique to identify normal ureter during pyeloplasty Histological sections from 31 patients with UPJO were analyzed for ICC and neurons on immunehistochemistry and CM ratio on Massons trichrome staining Post operative outcomes were analyzed at one year follow up expressed as excellent moderate or mild improvement static and deterioration based on the three factors ultrasound grade differential renal function and renogram drainage pattern The pathological findings were correlated with clinical outcomes. Further research was performed to compare the efficacy of frozen section rapid Massons trichrome staining for collagen to muscle ratio The study group n equal to 31 had a mean age 2 point 9 0 point 6 years M F equal to 22 point 9 UPJ segment had significantly less ICC neurons and more collagen compared to normal ureter p equal to 0 point 001 Pathological parameters at the anastomosed end of ureter had a better correlation than those at UPJ with clinical outcome CM ratio with a stronger correlation r equal to minus 0 point 94 p equal to 0 point 001 was a better predictor of prognosis than ICC r equal 0 point 76 p equal to 0 point 01 or neuron r equal to 0 point 83 p equal to 0 point 01 density ICC greater than 10 HPF neurons greater than 6 HPF and CM ratio less than 1 point 2 at ureteric end anastomosed were predictors of success Pathological markers at the anastomosed end of ureter correlate better with clinical outcomes than those at UPJ Sending the resected end of the ureter for collagen to muscle ratio analysis gives the best possible prognostic prediction on pyeloplasty outcomes It is feasible to intraoperatively identify normal ureter distal to UPJO using CMR analysis on the novel rapid frozen section technique reported newline