Bladder muscular wall regeneration with autologous adipose mesenchymal stem cells on three-dimensional collagen-based tissue-engineered prepuce and biocompatible nanofibrillar scaffold.

OBJECTIVE: Tissue-engineered prepuce scaffold (TEPS) is a collagen-rich matrix with marvelous mechanical properties, promoting in vivo and in vitro tissue regeneration. In this study, adipose-derived mesenchymal stem cells (ADMSCs) were used to seed TEPS for bladder wall regeneration. Its potential in comparison with other materials such as polyglycolic acid (PGA) and nanofibrous scaffolds were evaluated. MATERIALS AND METHODS: Rat ADMSCs were cultured and seeded into prepared TEPS. A synthetic matrix of electrospun nanofibrous polyamide was also prepared. Sprague Dawley rats (n=32) underwent bladder wall regeneration using (a) TEPS, (b) TEPS+PGA, (c) TEPS+nanofibrous scaffold, and (d) ADMSC-seeded TEPS, between bladder mucosa and seromuscular layer. Animals were followed for 30 and 90 days post implantation for evaluation of bladder wall regeneration by determining CD31/34 and SMC α-actin. Cystometric evaluation was also performed in all groups and in four separate rats as sham controls 3 months postoperatively. RESULTS: Histopathological analysis showed well-organized muscular wall generation in ADMSC-seeded TEPS and TEPS+three-dimensional (3D) nanofibrous scaffold without significant fibrosis after 90 days, while mild to severe fibrosis was detected in groups receiving TEPS and TEPS+PGA. Immunohistochemistry staining revealed the maintenance of CD34+, CD31+, and α-SMA in ADMSC-seeded TEPS and TEPS+3D nanofibrous scaffold with significantly higher density of CD34+ and CD31+ progenitor cells in ADMSC-seeded TEPS and TEPS+3D nanofibrous scaffold, respectively. CONCLUSIONS: This work has crucial functional and clinical implications, as it demonstrates the feasibility of ADMSC-seeded TEPS in enhancing the properties of TEPS in terms of bladder wall regeneration.

Endoureterotomy as the initial management of concurrent ureteropelvic and ureterovesical junction obstruction after failed conservative therapy.

OBJECTIVE: To present the results of our experience with endoureterotomy as the initial management of ureterovesical junction obstruction (UVJO) with coexisting primary or secondary obstruction at the ureteropelvic junction (UPJO) level. METHODS: A total of 490 children with 561 ureterorenal units were referred to our center for further management of UVJO. Of these, 47 ureterorenal units had concomitant UPJO. All patients underwent endoureterotomy. Patients were monitored by performing clinical examinations, urine culture, ultrasonography, and radionuclide renal scan. RESULTS: Mean procedure time for endoureterotomy was 20 minutes (range, 14-33 minutes). No postoperative complications were observed. With a mean follow-up of 27 months, 39 of the 47 ureters with concomitancy (82.97%) showed resolution of both pathologies after the initial endoureterotomy, and 4 patients experienced resolution after redo endoureterotomy, with an overall success rate of 91.48%. Three ureterorenal units (6.38%) underwent further ureteral reimplantation. Pyeloplasty was performed on 3 ureterorenal units (6.38%), which led to complete resolution in all. CONCLUSION: Performing initial endoureterotomy for the management of UVJO concomitant with UPJO provides promising results in spontaneous resolution of UPJO and complete resolution or decrease in hydronephrosis and can be proposed as an effective and safe temporizing alternative in selected patients.

Concomitant urethral triplication, bladder, and colon duplication.

The concomitant presence of urethral triplication and caudal duplication is extremely rare with no previous reported cases. We report a case of urethral triplication associated with bladder, sigmoid, and rectum duplication. The patient was initially referred with a history of fecaluria and recurrent urinary tract infection. Physical examination revealed 2 meatal opening on the glans penis. Further investigation revealed three distinct urinary streams, two terminating on the glans penis, and one in the rectum in voiding cystourethrography and retrograde urethrography. Computed tomography demonstrated the bladder divided into two compartments by a complete sagittal septum. The patient was managed by the excision of the rectal ending urethra and removal of the bladder sagittal septum during which, two sigmoidal and rectal segments (the right one filled with fecal) were revealed. The right sigmoid and rectum was resected. The two ventral urethras were kept intact. The postoperative course was uneventful. At his 4 month readmission for colostomy closure, the patient reported good urethral voiding with no complication and recurrence of urinary tract infection and the colostomy was closed with no major complication.

Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants.

PURPOSE: Open dismembered pyeloplasty is usually performed through flank, anterior subcostal or posterior lumbotomy incisions. These incisions are cosmetically less acceptable and may produce significant postoperative pain. We present the smallest incision for open pyeloplasty, called a 'miniature pyeloplasty'. The aim of this study was to reduce hospital stay and postoperative pain, along with enhanced cosmetic results. PATIENTS AND METHOD: 373 infants (mean age 4 months) with hugely dilated pelvises underwent the miniature pyeloplasty. The exact site of incision was determined by intraoperative renal ultrasonography and palpation. A muscle-splitting incision was made in the most dependent part of the lower quadrant. After meticulous dissection of the ureteropelvic junction component, the affected section was pulled out and underwent classic dismembered pyeloplasty without renal pelvis reduction. All children had long-duration stented anastomoses. Surgical incision size, operative time, hospital stay, postoperative analgesic use and complication rate were recorded. RESULTS: The operation was successful in all patients. The mean operative time was 53 min (range 43-75) and patients were discharged after 18 ± 3 (mean ± SD) h. Incision size ranged from 11 to 15 mm (mean 13). No narcotic analgesic was required postoperatively and there were no major complications during follow up. CONCLUSIONS: Miniature pyeloplasty is a safe and successful technique for ureteropelvic junction obstruction that avoids long operative time with negligible postoperative pain compared to the classic open pyeloplasty in infants. The exact incision site must be reconfirmed intraoperatively by physical examination or renal ultrasonography.