Pediatric Urology Research Center

Tehrān, Iran

Pediatric Urology Research Center

Tehrān, Iran
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Talab S.S.,Pediatric Urology Research Center | Kajbafzadeh A.-M.,Pediatric Urology Research Center | Elmi A.,Pediatric Urology Research Center | Tourchi A.,Pediatric Urology Research Center | And 3 more authors.
BJU International | Year: 2014

Objective To investigate the feasibility of a new approach for cystoplasty using autologous smooth muscle cell (SMC) sheet and scaffold-less bladder tissue engineering with the main focus on histological outcomes in a rabbit model. Materials and Methods In all, 24 rabbits were randomly divided into two groups. In the experimental group, SMCs were obtained from the bladder muscular layer, labelled with PKH-26, and seeded on temperature-responsive culture dishes. Contiguous cell sheets were noninvasively harvested by reducing the temperature and triple-layer cell-dense tissues were constructed. After partial detrusorectomy, the engineered tissue was transplanted onto the urothelial diverticulum. The control group underwent partial detrusorectomy followed by peritoneal fat coverage. At 2, 4, and 12 weeks the rabbits were humanely killed and haematoxylin and eosin, Masson's trichrome, cluster of differentiation 34 (CD34), CD31, CD3, CD68, α-smooth muscle actin (α-SMA), picrosirius red, and pentachrome staining were used to evaluate bladder reconstruction. Results At 2 weeks after SMC-sheet grafting, PKH-26 labelled SMCs were evident in the muscular layer. At 4 weeks, 79.1% of the cells in the muscular layer were PKH-positive cells. The portion of the muscular layer increased in the experimental group during the follow-up and was similar to normal bladder tissue after 12 weeks. α-SMA staining showed well organised muscle at 4 and 12 weeks. CD34+ endothelial progenitor cells and CD31+ microvessels increased continuously and peaked 4 and 12 weeks after grafting, respectively. Conclusion In the present study, we show that autologous SMC-sheet grafting has the potential for reliable bladder reconstruction and is technically feasible with a favourable evolution over the 12 weeks following implantation. Our findings could pave the way toward future bladder tissue engineering using the SMC-sheet technique. © 2014 The Authors. BJU International © 2014 BJU International.


Kajbafzadeh A.-M.,Pediatric Urology Research Center | Tourchi A.,Pediatric Urology Research Center | Bazargani S.,Pediatric Urology Research Center | Nezami B.G.,Pediatric Urology Research Center
Journal of Urology | Year: 2010

Purpose: We describe a single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy technique in infants. Materials and Methods: A total of 22 patients with ureteropelvic junction obstruction and concomitant inguinal hernia were referred to our center between November 2003 and November 2008. A total of 13 patients (mean age 5 months) with extensively dilated pelves (extending down to pelvic cavity) and ipsilateral inguinal hernia underwent single incision miniature open pyeloplasty and retroperitoneal herniorrhaphy. All patients had decreased differential renal function (less than 40%), urinary tract infection, palpable kidney and obstructive pattern on renal diethylenetriamine pentaacetic acid scan. The incision was made along the most dependent part of the lower quadrant. After dissection of the ureteropelvic junction component, we pulled out the affected section and performed classic dismembered pyeloplasty without renal pelvis reduction. Next, we performed retroperitoneal herniorrhaphy from the same incision. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded for further evaluation. Results: The operation was uneventful in all patients. Mean operative time was 64 minutes (range 47 to 93) and patients were discharged home after a mean ± SD of 19 ± 3 hours (15 to 24). Incision size was 12 to 18 mm and the incision was closed by inserting a mini Hemovac® closed drain. No narcotic supplementation was required postoperatively and there were no complications during followup. Conclusions: Single incision miniature pyeloplasty with ipsilateral inguinal herniorrhaphy in an extensively dilated pelvis and ipsilateral inguinal hernia is technically feasible and safe in selected cases. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasound. The technique adds the advantages of minimally invasive procedures (small incision, negligible postoperative pain) to the short operative time and high success rate of the open approach. © 2010 American Urological Association Education and Research, Inc.


Kajbafzadeh A.-M.,Pediatric Urology Research Center | Elmi A.,Pediatric Urology Research Center | Talab S.S.,Pediatric Urology Research Center | Emami H.,Pediatric Urology Research Center | And 2 more authors.
Journal of Urology | Year: 2010

Purpose: We evaluated the predictive role of serum and urinary carbohydrate antigen 19-9 in the diagnosis and followup of pediatric ureteropelvic junction obstruction. Materials and Methods: The study included 27 children with ureteropelvic junction obstruction who underwent pyeloplasty (group 1), and 41 controls consisting of 27 healthy children (group 2) and 14 children with hydrocele/renal cyst (group 3). Serum and voided urine were evaluated for carbohydrate antigen 19-9 in each group. Additionally urine from the affected pelvis and fluid in hydrocele/renal cyst were collected at surgery in groups 1 and 3. Serum and voided urine samples were obtained at 3, 6 and 9 months after pyeloplasty for carbohydrate antigen 19-9 assessment, and were correlated with clinical factors. Results: Preoperative carbohydrate antigen 19-9 level was significantly greater in group 1 than in controls. The best cutoff values for serum and urinary carbohydrate antigen 19-9 were 13.21 U/ml and 30.6 U/ml, respectively, with significantly higher sensitivity and specificity for urinary values. Obstruction release was followed by improvement of renal function together with significant reduction in urinary and serum carbohydrate antigen 19-9 at 3 months. Initial pelvis diameter and renographic function significantly correlated with urinary carbohydrate antigen 19-9. No significant correlation was found regarding serum carbohydrate antigen 19-9. Conclusions: Voided urine carbohydrate antigen 19-9 is a noninvasive, clinically applicable marker in congenital obstructive nephropathy. The practical implications of these data for diagnosis and long-term followup in ureteropelvic junction obstruction are significant. Our findings suggest that proper decrease in urinary carbohydrate antigen 19-9 after pyeloplasty is predictive of excellent surgical outcomes and resolution of renal damage. © 2010 American Urological Association Education and Research, Inc.


PubMed | Pediatric Urology Research Center
Type: Journal Article | Journal: BJU international | Year: 2014

To investigate the feasibility of a new approach for cystoplasty using autologous smooth muscle cell (SMC) sheet and scaffold-less bladder tissue engineering with the main focus on histological outcomes in a rabbit model.In all, 24 rabbits were randomly divided into two groups. In the experimental group, SMCs were obtained from the bladder muscular layer, labelled with PKH-26, and seeded on temperature-responsive culture dishes. Contiguous cell sheets were noninvasively harvested by reducing the temperature and triple-layer cell-dense tissues were constructed. After partial detrusorectomy, the engineered tissue was transplanted onto the urothelial diverticulum. The control group underwent partial detrusorectomy followed by peritoneal fat coverage. At 2, 4, and 12 weeks the rabbits were humanely killed and haematoxylin and eosin, Massons trichrome, cluster of differentiation 34 (CD34), CD31, CD3, CD68, -smooth muscle actin (-SMA), picrosirius red, and pentachrome staining were used to evaluate bladder reconstruction.At 2 weeks after SMC-sheet grafting, PKH-26 labelled SMCs were evident in the muscular layer. At 4 weeks, 79.1% of the cells in the muscular layer were PKH-positive cells. The portion of the muscular layer increased in the experimental group during the follow-up and was similar to normal bladder tissue after 12 weeks. -SMA staining showed well organised muscle at 4 and 12 weeks. CD34+ endothelial progenitor cells and CD31+ microvessels increased continuously and peaked 4 and 12 weeks after grafting, respectively.In the present study, we show that autologous SMC-sheet grafting has the potential for reliable bladder reconstruction and is technically feasible with a favourable evolution over the 12 weeks following implantation. Our findings could pave the way toward future bladder tissue engineering using the SMC-sheet technique.

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