[When to suspect ureteral injury?]. / Milloin tulisi epäillä virtsanjohtimen vauriota?

Ureteral injuries associated with treatment procedures have been in constant rise. Laparoscopic operations within the lesser pelvis constitute their most common cause. Most injuries are detected only after days or weeks after the operation, with only one fifth being noted during the operation. In the worst case, ureteral injury may lead to complete renal failure. The earlier the injury is detected and treated by stenting or an open operation, the better is the treatment outcome. The ureter must be either stented or repaired by an open operation in order to repair the injury.

17beta-estradiol induces the proliferation of the in vitro cultured human urothelium.

OBJECTIVE: The genitourinary tract is considered to be a target for the actions of sex steroid hormones. Decreased ovarian function and lack of estrogen after menopause are associated with lower genitourinary tract symptoms as well as bladder dysfunctions such as incontinence. Estrogen may also affect urothelial cells. The estrogen receptors (ERs) are found in the mucosa of the urinary tract. The purpose of this study was to culture human urothelial cells (HUCs) originating from urothelial tissue biopsies and to use them as a reproducible test platform to evaluate the effect of 17beta-estradiol (E2). MATERIAL AND METHODS: Urothelial tissue biopsies were obtained from 95 patients undergoing gynaecological open surgery for urinary incontinence, paediatric vesicoureteral reflux or transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. HUCs originating from biopsies were cultured in vitro in the absence or in the presence of 0.1 nmol, 0.01 micromol and 1 micromol of E2. ER expression of the cultured HUCs was examined by Western analysis and immunofluorescence microscopy, which was also used for HUC characterization. The effect of E2 in the proliferation of the HUCs was determined by tetrazolium salt 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT)-assay. RESULTS: HUCs were cultured successfully in four to six passages but there was variation between samples. The cultured cells showed expression of beta(4)-integrin, E-cadherin and cytokeratins 7, 8, 9 and 19, indicating the epithelial origin of the cells. Both types of ERs, ERalpha and ERbeta, were found in the in vitro cultured HUCs. E2 treatment of HUCs did not affect remarkably the expression of ERalpha but cell proliferation was induced. However, no concentration-dependent effect was seen. CONCLUSIONS: This study indicates that HUCs originating from small tissue biopsies can be cultured in several passages in vitro and could have potential in repairing or restoring urinary tract tissue by tissue engineering therapy. HUCs serve as a good in vitro test platform, as shown by analysing E2-treated HUCs. E2 induced the proliferation of cultured HUCs even though concentration dependency was not observed. The findings of this study may have relevance in determining the mechanisms of estrogen therapy in postmenopausal urinary tract symptoms and in the future development of tissue engineering technology.

Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery.

OBJECTIVE: There is an impression that ureteric injuries have become more common during the past decade, and therefore this study aimed to determine the incidence, aetiology, features, treatment and outcomes of ureteric injuries over an extended period. MATERIAL AND METHODS: Records of patients treated for ureteric injury in 1986--2006, divided into three 7-year periods, were reviewed retrospectively. The numbers of open and laparoscopic gynaecological, surgical and endourological operations were ascertained. RESULTS: All 72 ureteric injuries recorded were iatrogenic, being diagnosed in 60 females and 11 males (mean age 52 years). Only five injuries occurred during the first 7-year period (1986--1992), but the incidence was markedly higher during the following two 7-year periods, 28 (1993--1999) and 39 (2000--2006), respectively. The injuries were mostly secondary to gynaecological procedures (64%) or general surgery (25%). Only 11% occurred in association with a urological procedure. The cause was mostly laparoscopic (56%) or open surgery (33%), and the injury was in most cases located in the lower ureter (89%). The diagnosis was usually delayed (in 79%), with a median time to diagnosis of 6 days. The injuries were managed by ureteroneocystostomy (49%), a ureteral stent (19%) or end-to-end anastomosis (12%). The complication rate was 36%. CONCLUSIONS: Iatrogenic ureteric injuries have increased markedly during the past two decades. Gynaecological laparoscopic procedures account for more than half of the injuries, and the most common location is the lower ureter. Most injuries are treated by ureteroneocystostomy, but endourological treatment yields acceptable results. To improve the management of ureteric injury there must be a high index of suspicion, especially during laparoscopic operations.