Evaluation of PGP 9.5, NGFR, TGFβ1, FGFR1, MMP-2, AT2R2, SHH, and TUNEL in Primary Obstructive Megaureter Tissue

Primary obstructive megaureter (POM) morphogenesis is not fully known. The aim of the study was to evaluate the appearance of different factors that might take part in the pathogenesis of POM. Megaureter tissues of 14 children were stained with hematoxylin and eosin as well as with immunohistochemistry for protein gene product 9.5, nerve growth factor receptor, transforming growth factor beta 1 (TGFβ1), fibroblast growth factor receptor 1 (FGFR1), matrix metalloproteinase 2 (MMP-2), angiotensin 2 receptor type 2, and sonic hedgehog (SHH) protein. Apoptosis was detected by terminal dUTP nick-end labeling reaction. POM tissues revealed transitional epithelium with scattered vacuolization, submucosa with inflammatory cells, and focally vacuolized and chaotically organized muscle layers. Apoptosis, appearance of MMP-2, FGFR1, and SHH prevailed, but TGFβ1 positive cell number was lower in patients. Correlation between MMP-2 in epithelium and endothelium, FGFR1 and MMP-2 in epithelium, and TGFβ1 in epithelium and connective tissue in patients was detected. POM morphopathogenesis involves an apoptotic cell death of epithelium and smooth muscle as well as tissue degradation in epithelium and connective tissue of the ureter wall. The decrease of tissue growth through diminished TGFβ1 expression and stimulation of FGFR1 and MMP-2 suggests a disbalance of tissue remodelation in the megaureter wall:

A rare case of bilateral obstructive megaureter with a giant uretal ureterocele on the left

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.