RESUMO
PURPOSE: To compare the efficacy of pathological markers like Interstitial cells of Cajal (ICC), neurons and Collagen to Muscle ratio (CM ratio), in predicting pyeloplasty outcomes. METHODS: Histological sections from 31 patients with UPJO were analyzed for ICC & neurons on immuno-histochemistry and CM ratio on Masson's trichrome staining. Post-operative outcomes were analyzed at 1-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. RESULTS: The study group (nâ¯=â¯31) had a mean age 2.9 (0.6) years (M: Fâ¯=â¯22:9). UPJ segment had significantly less ICC/neurons and more collagen compared to normal ureter (pâ¯=â¯0.001). 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 (râ¯=â¯- 0.94; pâ¯=â¯0.001) was a better predictor of prognosis than ICC (râ¯=â¯0.76; pâ¯=â¯0.01) or neuron (râ¯=â¯0.83; pâ¯=â¯0.01) density. ICC >10/HPF, neurons >6/HPF and CM ratio <1.2 at ureteric end anastomosed were predictors of success. CONCLUSIONS: CM ratio analysis at anastomosed ureter is a superior marker for predicting pyeloplasty outcomes. LEVEL OF EVIDENCE: Type 2: Development of diagnostic criteria in a consecutive series of patients.