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Comparison of histopathological characteristics of polyacrylate polyalcohol copolymer with dextranomer/hyaluronic acid after injection beneath the bladder mucosa layer: a rabbit model

  • Urology - Original Paper
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Abstract

Objectives

To compare short- and long-term local tissue reaction of polyacrylate polyalcohol copolymer (PPC) with dextranomer/hyaluronic acid (DHA) in rabbits.

Methods

Eight healthy New Zealand rabbits were randomly divided into two groups. In group I (control group), DHA was injected just beneath the mucosal layer of the bladder wall, while PPC was injected in group II. Subcutaneous injection of both bulking agents was also performed in nude mice. Histological evaluations with leukocyte common antibody (LCA), CD68, CD31, and CD34 were conducted on biopsies 1 and 6 months postoperatively. Scanning electron microscopy (SEM) and MTT assay were also performed for these two bulking agents.

Results

SEM images revealed larger particle size of PPC. LCA and CD68 staining was significantly higher in group II as compared with group I in both short- and long-term follow-ups. However, in groups I and II, expression of CD31 (101 ± 0.5 vs. 92 ± 0.25, p > 0.05) and CD34 (115 ± 0.75 vs. 103 ± 0.5, p > 0.05) was not significantly different in long-term follow-up. Remarkably, severe fibrosis was observed in group II as compared to mild fibrosis in group I one month after injection. The results of in vivo application of these bulking agents in nude mice were in accordance with the results obtained from rabbit model. MTT assay revealed that cell proliferation was significantly higher in the presence of DHA as compared with PPC.

Conclusion

Severe inflammation and fibrosis in PPC may be due to continued foreign body reaction, presence of alcohol polymers, or larger particle sizes.

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Abbreviations

LCA:

Leukocyte common antigen

VUR:

Vesicoureteral reflux

PPC:

Polyacrylate polyalcohol copolymer

DHA:

Dextranomer/hyaluronic acid

References

  1. Matouschek E (1981) Treatment of vesicorenal reflux by transurethral teflon-injection (author’s transl). Der Urologe Ausg A 20(5):263–264

    CAS  PubMed  Google Scholar 

  2. O’Donnell B, Puri P (1984) Treatment of vesicoureteric reflux by endoscopic injection of Teflon. J urol 167(4):1808–1809

    Article  Google Scholar 

  3. De Vocht TF, Chrzan R, Dik P, Klijn AJ, De Jong TP (2010) Long-term results of bulking agent injection for persistent incontinence in cases of neurogenic bladder dysfunction. J Urol 183(2):719–723. doi:10.1016/j.juro.2009.10.044

    Article  PubMed  Google Scholar 

  4. Chertin B, Kocherov S (2010) Long-term results of endoscopic treatment of vesicoureteric reflux with different tissue-augmenting substances. J Pediatr Urol 6(3):251–256. doi:10.1016/j.jpurol.2009.10.011

    Article  PubMed  Google Scholar 

  5. Chertin B, Puri P (2002) Endoscopic management of vesicoureteral reflux: does it stand the test of time? Eur Urol 42(6):598–606

    Article  PubMed  Google Scholar 

  6. Malizia AA Jr, Reiman HM, Myers RP, Sande JR, Barham SS, Benson RC Jr, Dewanjee MK, Utz WJ (1984) Migration and granulomatous reaction after periurethral injection of polytef (Teflon). JAMA 251(24):3277–3281

    Article  PubMed  Google Scholar 

  7. Ormaechea M, Ruiz E, Denes E, Gimenez F, Denes FT, Moldes J, Amarante A, Pioner G, Dekermacher S, de Badiola F (2010) New tissue bulking agent (polyacrylate polyalcohol) for treating vesicoureteral reflux: preliminary results in children. J Urol 183(2):714–717. doi:10.1016/j.juro.2009.10.047

    Article  CAS  PubMed  Google Scholar 

  8. Stenberg A, Lackgren G (1995) A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results. J Urol 154(2 Pt 2):800–803

    CAS  PubMed  Google Scholar 

  9. Lightner D, Rovner E, Corcos J, Payne C, Brubaker L, Drutz H, Steinhoff G, Zuidex Study G (2009) Randomized controlled multisite trial of injected bulking agents for women with intrinsic sphincter deficiency: mid-urethral injection of Zuidex via the Implacer versus proximal urethral injection of Contigen cystoscopically. Urology 74(4):771–775. doi:10.1016/j.urology.2009.05.034

    Article  Google Scholar 

  10. Kirsch AJ, Perez-Brayfield M, Smith EA, Scherz HC (2004) The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter. J Urol 171(6):2413–2416

    Article  PubMed  Google Scholar 

  11. Elder JS, Shah MB, Batiste LR, Eaddy M (2007) Part 3: Endoscopic injection versus antibiotic prophylaxis in the reduction of urinary tract infections in patients with vesicoureteral reflux. Curr Med Res Opin 23(Suppl 4 (S4)):S15–S20. doi:10.1185/030079907X226230

    Article  PubMed  Google Scholar 

  12. Caione P, Capozza N (2002) Endoscopic treatment of urinary incontinence in pediatric patients: 2-year experience with dextranomer/hyaluronic acid copolymer. J Urol 168(4 Pt 2):1868–1871

    Article  CAS  PubMed  Google Scholar 

  13. Stenberg A, Sundin A, Larsson B, Lackgren G, Stenberg A (1997) Lack of distant migration after injection of A sup 125 iodine labeled dextranomer based implant into the rabbit bladder. J Urol 158(5):1937–1941

    Article  CAS  PubMed  Google Scholar 

  14. Stredele RJ, Dietz HG, Stehr M (2013) Long-term results of endoscopic treatment of vesicoureteral reflux in children: comparison of different bulking agents. J Pediatr Urol 9(1):71–76. doi:10.1016/j.jpurol.2011.12.004

    Article  PubMed  Google Scholar 

  15. Moore K, Bolduc S (2014) Prospective study of polydimethylsiloxane vs dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux. J Urol 192(6):1794–1799. doi:10.1016/j.juro.2014.05.116

    Article  CAS  PubMed  Google Scholar 

  16. Ben-Meir D, Morgenstern S, Sivan B, Efrat R, Livne PM (2012) Histology proved malpositioning of dextranomer/hyaluronic acid in submucosal ureter in patients after failed endoscopic treatment of vesicoureteral reflux. J Urol 188(1):258–261. doi:10.1016/j.juro.2012.03.019

    Article  CAS  PubMed  Google Scholar 

  17. Chertin B, Arafeh WA, Zeldin A, Kocherov S (2011) Preliminary data on endoscopic treatment of vesicoureteric reflux with polyacrylate polyalcohol copolymer (Vantris): surgical outcome following single injection. J Pediatr Urol 7(6):654–657

    Article  PubMed  Google Scholar 

  18. Chertin B, Arafeh WA, Zeldin A, Ostrovsky IA, Kocherov S (2013) Endoscopic correction of VUR using vantris as a new non-biodegradable tissue augmenting substance: three years of prospective follow-up. Urology 82(1):201–204

    Article  PubMed  Google Scholar 

  19. Sharifiaghdas F, Tajalli F, Otukesh H, Shamsabadi RH (2014) Endoscopic correction of primary VUR by using polyacrylate polyalcohol copolymer (Vantris) in young girls: 2-year follow-up. J Pediatr Urol 10(6):1032–1036. doi:10.1016/j.jpurol.2014.02.016

    Article  PubMed  Google Scholar 

  20. Kocherov S, Ulman I, Nikolaev S, Corbetta JP, Rudin Y, Slavkovic A, Dokumcu Z, Avanoglu A, Menovshchikova L, Kovarskiy S (2014) Multicenter survey of endoscopic treatment of vesicoureteral reflux using polyacrylate-polyalcohol bulking copolymer (vantris). Urology 84(3):689–693

    Article  PubMed  Google Scholar 

  21. Sencan A, Yildirim H, Ozkan KU, Ucan B, Hosgor M (2014) Open ureteroneocystostomy after failed endoscopic injection with three different bulking agents for the treatment of vesicoureteral reflux. J Pediatr Surg 49(11):1652–1655. doi:10.1016/j.jpedsurg.2014.04.012

    Article  PubMed  Google Scholar 

  22. Alizadeh F, Mazdak H, Khorrami MH, Khalighinejad P, Shoureshi P (2013) Postoperative ureteral obstruction after endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer (Vantris®). J Pediatr Urol 9(4):488–492

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib’s St, Keshavarz Blvd, Tehran, 4194 33151, Iran

    Abdol-Mohammad Kajbafzadeh, Shabnam Sabetkish, Reza Khorramirouz & Nastaran Sabetkish

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  1. Abdol-Mohammad Kajbafzadeh
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  2. Shabnam Sabetkish
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  3. Reza Khorramirouz
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  4. Nastaran Sabetkish
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Correspondence to Abdol-Mohammad Kajbafzadeh.

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None of the authors has direct or indirect commercial financial incentive associating with publishing the article and does not have any conflict of interest, and will sign the Disclosing Form.

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All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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Kajbafzadeh, AM., Sabetkish, S., Khorramirouz, R. et al. Comparison of histopathological characteristics of polyacrylate polyalcohol copolymer with dextranomer/hyaluronic acid after injection beneath the bladder mucosa layer: a rabbit model. Int Urol Nephrol 49, 747–752 (2017). https://doi.org/10.1007/s11255-017-1540-z

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  • DOI: https://doi.org/10.1007/s11255-017-1540-z

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