Successful salvage of kidney allografts threatened by ureteral stricture using pyelovesical bypass.

Ureteral stricture is the most common urologic complication after renal transplantation. When endourologic management fails, open ureteral reconstruction remains the standard treatment. The complexity of some of these procedures makes it necessary to explore other means of repair. This study evaluated the intermediate-term outcome of subcutaneous pyelovesical bypass graft (SPBG) on renal transplant recipients. We reviewed 8 patients (6 male and 2 female; mean age 52 years) with refractory ureteral strictures postrenal transplantation, who received SPBG as salvage therapy. All patients failed endourologic management and half failed open management of their strictures. After a mean follow-up of 19.4 months, 7 out of 8 renal grafts have good function with mean GFR of 58.5 mL/min/1.73 m(2), without evidence of obstruction or infection. One patient lost his graft due to persistent infection of the SPBG and one patient developed a recurrent urinary tract infection managed with long-term antibiotics. SPBG offers a last resort in the treatment of ureteral stricture after renal transplantation refractory to conventional therapy.

Expression and regulation of H+K+ATPase in lysosomes of epithelial cells of the adult rat epididymis.

Endocytosis is an important event in the epididymis as it contributes to a luminal environment conducive for sperm maturation. Principal and clear cells contain numerous lysosomes which degrade many substances internalized by endocytosis from the epididymal lumen. The interior of the lysosomes depends on low pH to activate the release of their enzymes and to activate their acid hydrolases. In the present study, H+K+ATPase was localized by light microscopy in the adult rat epididymis of intact and of orchidectomized animals supplemented with testosterone or not. In normal animals, numerous lysosomes of nonciliated cells of the efferent ducts were intensely reactive for anti-H+K+ATPase antibody. In the initial segment, only a few lysosomes of principal cells were reactive. In the intermediate zone of the epididymis, numerous lysosomes of principal cells were intensely reactive, while the number of intensely reactive lysosomes decreased progressively from the proximal caput to the distal caput with none being seen in the proximal corpus region. In the distal corpus and cauda regions, only a few lysosomes of some principal cells were reactive. In contrast, clear cells of all regions showed intense reactivity. Orchidectomy resulted in the abolishion of H+K+ATPase in lysosomes of principal cells of all regions except the initial segment. However, while clear cells of the caput and corpus regions also became unreactive, those of the cauda region remained as reactive as in controls. Orchidectomized animals supplemented with testosterone maintained a staining pattern similar to controls for both cell types. These observations demonstrate the presence in principal and clear cells of H+K+ ATPase which may have an important role in acidifying the interior of their lysosomes. However, there is a region-specific expression of H+K+ATPase in lysosomes of principal cells, unlike that for clear cells. In addition, H+K+ATPase expression in lysosomes of principal cells depends on testosterone in all regions except the initial segment. However, in the case of clear cells, only those of the caput and the corpus regions are dependent on testosterone, while those of the cauda region appear to be regulated by some other factor.

Cathepsin A is expressed in a cell- and region-specific manner in the testis and epididymis and is not regulated by testicular or pituitary factors.

The epithelial cells of the testis are involved in the production, differentiation, and sustenance of sperm, and those of the epididymis play a major role in sperm maturation, protection, and storage. These tissues express various proteins that respond differently to androgens. Cathepsin A is a multifunctional lysosomal carboxypeptidase that also functions as a protective and an activator protein for neuraminidase and beta-galactosidase. In this study, cathepsin A was immunolocalized by light and electron microscopy using a polyclonal affinity-purified antibody on the testis and epididymis of normal, orchidectomized with or without testosterone supplementation, efferent duct-ligated, and hypophysectomized adult rats. In normal rats, cathepsin A expression was noted in lysosomes of Sertoli and Leydig cells but not in germ cells of the testis, as well as nonciliated cells of the efferent ducts. In the epididymis, a cell- and region-specific distribution of cathepsin A was noted. In experimentally treated animals, no changes were noted in the expression of cathepsin A. Immunolabeling of tissues examined at the electron microscopic level revealed that lysosomes were reactive. These data indicate cell- and region-specific expression of cathepsin A in cells of the testis and epididymis and also indicate that cathepsin A expression is not regulated by testicular or pituitary factors.

Immunolocalization of CA II and H+ V-ATPase in epithelial cells of the mouse and rat epididymis.

Acidification of the epididymal lumen has been suggested to play an important role in sperm functions; however, the cell types, pumps, and mechanisms involved have not been fully addressed. In this study, carbonic anhydrase II (CA II) and a 67-kd subunit of Neurospora crassa vacuolar proton adenosinetriphosphatase (H+ V-ATPase) pump were immunolocalized using light microscopy and electron microscopy (EM) in the epididymis of rats and mice. In both animals, narrow cells, identified in the initial segment and intermediate zone of the epididymis, contained numerous small vesicles in their apical region, often cup-shaped in appearance. In the mouse but not rat, these cells also possessed numerous cisternae of smooth endoplasmic reticulum, suggesting steroid synthesis; and cytoplasmic blebs of their apical cell surface, which appeared to detach, suggesting apocrine secretion. Anti-CA II antibody was immunocytochemically localized in the light microscope within narrow cells but not over any other cell types of the entire epididymis. Anti-H+ V-ATPase antibody was also localized in narrow cells of the initial segment and intermediate zone; as well as clear cells of the caput, corpus, and cauda regions. Using EM, gold particles for anti-CA II and H+ V-ATPase antibodies were noted in the apical region of narrow cells in relation to the numerous, small, cup-shaped vesicles. Although CA II was mainly located in the cytosol near these vesicles, H+ V-ATPase appeared on their delimiting membrane and on the apical plasma membrane of these cells. A similar distribution was noted for H+ V-ATPase in clear cells. The nature of the small vesicles of the apical region of narrow cells was examined with electron-dense fluid phase tracers that were introduced into the epididymal lumen. The tracers appeared within these vesicles and a few endosomes 1 hour after injection, suggesting that they contact the apical plasma membrane. Since these vesicles are also related to CA II and H+ V-ATPase, the data suggests that, as the site of proton production, the vesicles recycle to and from the apical cell surface, and in this way, deliver protons to the epididymal lumen for acidification. Clear cells and their expression of H+ V-ATPase may also serve in this function. In summary, both narrow and clear cells appear to be involved in luminal acidification, an activity that may be essential for sperm as they traverse and are stored in the epididymis.

Cell- and region-specific localization of lysosomal and secretory proteins and endocytic receptors in epithelial cells of the cauda epididymidis and vas deferens of the adult rat.

The epithelial cells lining the cauda epididymidis and vas deferens are active in endocytosis and have an abundance of lysosomes and a well-characterized secretory apparatus. However, little is known about the nature of lysosomal proteins contained within lysosomes, the types of receptors on the cell surface, and the types of proteins secreted by these cells. In the present study, cathepsins A, D, B, and sulfated glycoprotein (SGP)-1, well-characterized lysosomal proteins, as well as SGP-2, a secretory protein and low-density lipoprotein receptor-related protein-2 (LRP-2), an endocytic receptor, were immunolocalized at the light-microscopic level within epithelial cells of the cauda epididymidis and vas deferens. Principal cells showed numerous intensely reactive lysosomes for cathepsins A, D, and SGP-1 in all regions of the cauda and vas deferens and for cathepsin B only in the cauda epididymidis. Basal cells were intensely reactive for cathepsin A, unreactive for cathepsins D and B, and weakly reactive for SGP-1 in the cauda region. In the vas deferens, these cells were intensely reactive for cathepsin A and SGP-1 and unreactive for cathepsin B; in the case of cathepsin D, basal cells were weakly reactive in the proximal vas deferens but intensely reactive in the middle and distal vas deferens. Clear cells, present in the cauda region and proximal vas deferens, were intensely reactive for cathepsin A, weakly reactive for SGP-1, and unreactive for cathepsins D and B, while narrow cells found mainly in the proximal vas deferens were intensely reactive for cathepsins A, D, and SGP-1 and unreactive for cathepsin B. Thus, the expression of different lysosomal enzymes in the cauda epididymidis and vas deferens is not only cell- but also region-specific, suggesting differences in the type of substrates internalized by these cells. SGP-2, a secretory protein, showed a checkerboardlike staining pattern in the cytoplasm of principal cells of the cauda epididymidis, while the cytoplasm of all principal cells were intensely reactive in the vas deferens. This type of reaction, as well as staining of sperm, suggests that SGP-2 is secreted into the lumen, where it functions in relation to sperm. The endocytic receptor LRP-2 was noted only on the apical surface of principal cells of the cauda and vas deferens and in spherical structures indicative of endosomes suggestive of their role in the uptake of various ligands, including SGP-2, for which it has a high binding affinity. Thus SGP-2 in the cauda and vas deferens is not only secreted but endocytosed by principal cells, suggestive of an active turnover in the lumen. In summary, the epithelial cells of the cauda and vas deferens show marked differences in expression of lysosomal proteins, SGP-2, and LRP-2 suggestive of differences in their functional activity while sperm are stored and protected in these regions.

Principal cells of the vas deferens are involved in water transport and steroid synthesis in the adult rat.

Principal cells show marked structural differences in the proximal, middle, and distal regions of the vas deferens, reflective of diverse functional activities. In the present study, we performed electron microscopy to examine the structural features of principal cells using glutaraldehyde-fixed, Epon-embedded material, while functional parameters were examined using light microscopic immunocytochemistry on Bouin-fixed, paraffin-embedded material. In the proximal region, the cuboidal principal cells resembled those of the cauda epididymidis, but few clear cells and occasional narrow cells were present. In the middle region, principal cells often contained blebs of their apical cytoplasm containing vesicular and tubular profiles. These blebs extended far from the cell surface and appeared to be liberated into the lumen, suggesting an apocrine type of secretion. In the distal region, dilated intercellular spaces containing numerous membranous profiles of different shapes and sizes were noted between adjacent principal cells and overlying basal cells. The use of an anti-aquaporin-1 antibody revealed an intense reaction over the endothelial cells of numerous vascular channels in the lamina propria. Taken together, these observations suggested water transport from the lumen of the vas deferens via the dilated spaces to underlying vascular channels, the function of which may be to concentrate sperm. The infranuclear cytoplasm of principal cells of this region showed whorls of smooth endoplasmic reticulum (sER). Large intracytoplasmic cavities were found within the sER aggregates, and these contained membranous profiles that appeared to peel off from the surrounding sER elements. Various images of such cavities closely juxtaposed to the lateral plasma membrane suggested that the membranous profiles of the intercellular spaces were derived from them. Use of anti-3beta-hydroxysteroid dehydrogenase antibody revealed an intense reaction over principal cells of the vas deferens, as well as over the blebs in the lumen of the vas deferens, which is indicative of the steroid synthesis performed by these cells. The release of sER membranous profiles into the dilated spaces and the presence of blebs in the lumen may represent a means of transporting steroids that are destined for different sites out of the principal cells. Steroids in the blebs would be ultimately destined for utilization by luminal sperm, while those steroids in the dilated spaces are designed for utilization by muscle layers of the lamina propria. In summary, principal cells of the vas deferens appear to be involved in synthesis and secretion of steroids and in eliminating water from the lumen of the vas deferens.

Immunocytochemical localization of the Ya, Yb1, Yc, Yf, and Yo subunits of glutathione S-transferases in the cauda epididymidis and vas deferens of adult rats.

Glutathione S-transferases (GSTs) are dimeric proteins grouped into five classes based on the degree of amino acid homology of their subunits. They are involved in cellular detoxification through the catalyzation of the conjugation of reduced glutathione with various electrophilic substances. In the present study, the distribution of Ya and Yc subunits from the alpha family, Yb1 and Yo subunits of the mu class, and the Yf subunit of the pi class were examined with light microscope immunocytochemistry in Bouin-fixed, paraffin-embedded tissue of different regions of the cauda epididymidis and vas deferens. In the cauda, principal cells showed high levels of expression of Ya, Yc, and Yo subunits, while in the vas deferens, staining decreased to moderate levels for the Ya and Yo subunits and to low levels for the Yc subunit. While Yf was maintained at low levels in principal cells of all cauda and vas deferens regions, Yb1 expression was more erratic, presenting a checkerboard-like staining pattern in the proximal vas deferens and showing moderate cytoplasmic but intense nuclear reactivity in all other regions. Basal cells in the cauda were intensely reactive for Yf, while in the vas deferens, they became unreactive. Conversely, basal cells were unreactive for Ya in the cauda and proximal vas deferens, while in the middle and distal vas deferens, they became moderately reactive. In the case of Yb1 and Yo, some basal cells were reactive while others appeared unreactive in all cauda and vas deferens regions. Yc elicited the display of both reactive and unreactive basal cells in the cauda regions, and while the cells were moderately reactive in the proximal vas deferens, they became intensely reactive in the middle and distal vas deferens. In summary, both principal and basal cells show varying degrees of GST expression in the different regions of the cauda and vas deferens, suggesting that these cells are subjected to a complex, changing environment of substrates. Furthermore, while expression often differs from principal to basal cells, the absence of reactivity of a given GST in one cell type is usually compensated for by expression in the other cell type in any given region of the cauda or vas deferens. Taken together, the data suggest that ample protection from harmful circulating electrophiles can be provided for sperm during their storage in the cauda and vas deferens. In addition, since principal cells of the vas deferens are involved in steroid synthesis, the presence of GSTs in these cells may also serve to bind steroids, or this presence may be involved in steroid isomerization.