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The intravesical ureter in children with vesicoureteral reflux: a morphological and immunohistochemical

Josef Oswald1, Erich Brenner, Christian Schwentner

  • 1Department of Pediatric Urology, University of Innsbruck, Austria.

The Journal of Urology
|November 25, 2003
PubMed

Insights

Vesicoureteral reflux in children damages the ureteral smooth muscle, causing atrophy and disordered fibers. This prevents the ureteral valve from functioning, leading to persistent reflux.

Area of Science:

  • Urology
  • Pediatric Surgery
  • Histopathology

Background:

  • Vesicoureteral reflux (VUR) is a common condition in children.
  • The intravesical ureteral tunnel plays a crucial role in preventing reflux.
  • Understanding the structural changes in the ureteral wall is vital for VUR management.

Purpose of the Study:

  • To investigate the morphology, smooth muscle architecture, and collagen composition of intravesical ureteral endings in children with VUR.
  • To compare these features with age-matched controls.

Main Methods:

  • Immunohistochemical analysis of 29 ureterorenal units from children with VUR.
  • Staining for actin, myosin, desmin, and CD68.
  • Histological examination using hematoxylin and eosin and Masson trichrome stains.
  • Comparison with non-refluxing ureteral specimens.

Main Results:

  • Decreased expression of smooth muscle markers (alpha-actin, myosin, desmin) in the distal ureter.
  • Evidence of muscle atrophy, degeneration, and disordered fibers.
  • Increased extracellular matrix collagen and CD68-positive macrophages.
  • Intact morphology in the proximal intravesical portion.

Conclusions:

  • Refluxing ureteral endings exhibit dysplasia, atrophy, and architectural derangement of smooth muscle.
  • These structural changes impair the active valve mechanism, preventing effective reflux prevention.
  • Findings highlight the structural basis for reflux persistence in affected children.
Abstract

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