Category: Basic Science: Stones

MP2-10 - Histopathological evaluation of inflammation in the ureteral wall after UAS usage during RIRS

Thu, Sep 20
4:00 PM - 6:00 PM

Introduction & Objective : Pro-inflammatory mediators have been shown to be significantly upregulated in ureteral wall tissue after retrograde intrarenal surgery (RIRS) using ureteral access sheaths (UAS). The objective of this study was to evaluate the histopathological evidence of inflammation in the ureteral wall after RIRS using UAS.

Methods : Ureteral access sheaths (UAS) sized 13/15 Fr. were inserted bilaterally in the ureters of 22 laboratory pigs (55kg). On one side the UAS was removed after 2 minutes followed by 2 hours of reperfusion and on the other side it was left in situ for 2 hours. After removal of the 2-hour UAS, both ureters were excised in vivo between the uretero-pelvic junction and the uretero-vesical junction. Embedded in paraffin 4 µm thick sections were step sectioned at 250-300 µm intervals and haematoxylin and eosin (HE) stained. An experienced pathologist performed histopathological scoring of acute neutrophilic inflammation in the ureteral wall. 0 = no inflammation; 1 = mild inflammation; 2 = severe inflammation.

Results :

There were 21 ureters in the 2-minute group and 22 in the 2-hour group. In total 3276 sections were evaluated. 14 sections were not evaluated due to artifacts. No ureters were without inflammation. Only 109 sections (3.3%) were with no sign of inflammation. 2269 sections (69.3%) showed mild inflammation and 878 sections (26.8%) showed severe inflammation.
In the 2-minute group 65 sections showed no sign of inflammation, 1103 showed mild inflammation and 479 showed severe inflammation. In the 2-hour group 44 sections showed no sign of inflammation, 1166 showed mild inflammation and 405 showed severe inflammation.
Comparison of short versus long-term UAS treatment yielded no statistically significant difference, but there was a trend towards a higher degree of inflammation after short-term treatment (1.25 (CI: 1.23-1.28) vs. 1.23 (CI: 1.21-1.25)), (p= 0.07). 

Conclusions : Mild to severe acute neutrophilic inflammation was evident in 96% of the ureteral wall tissue after treatment with UAS. There was no significant difference between short and long treatment duration. 

Soeren K. Lildal

Aarhus University Hospital, Skejby
Aarhus, Midtjylland, Denmark

Søren Kissow Lildal, MD, currently resident in urology at Aarhus University Hospital, Skejby, Denmark. Finished PhD Thesis "Ureteral Damage due to Acces Sheath Usage in Ureterorenoscopy" in January 2018 out of the Urological Research Department of Hospital Lillebaelt, Denmark.

Flemming B. Soerensen

Professor, Pathologist
Aarhus University Hospital, Skejby
Aarhus, Midtjylland, Denmark

Kim H. Andreassen

Gentofte Hospital
Copenhagen, Hovedstaden, Denmark

Helene U. Jung

Lillebaelt Hospital, Urology, Vejle, Denmark
Vejle, Syddanmark, Denmark

Malene R V.. Pedersen

Phd student
Lillebaelt Hospital, Vejle
Vejle, Syddanmark, Denmark

Palle J S. Osther

Professor of Clinical Urology
Lillebaelt Hospital, Urology, Vejle, Denmark
Vejle, Syddanmark, Denmark

Prof. Osther attended University Southern Denmark where he received his medical approval and M.D. in 1984. He was consultant urological surgeon at Odense University Hospital from 2000-2002; and at Lillebaelt Hospital from 2002 to 2004, when he became chair of the department. He received the Ph.D. degree for scientific work on pathophysiology of calcium nephrolithiasis in 1995.

Prof. Osther is currently Professor and consultant urological surgeon at Department of Urology and Director of Urological Research Center at Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark. His research interests focus on urolithiasis, upper urinary tract urothelial carcinoma, urinary tract pain, uroradiology, erectile dysfunction and prostate cancer. In his clinical practice he mainly deals with urinary stone disease and other upper urinary tract pathologies. In his areas of interest he has published extensively, and he has had numerous scientific presentations worldwide. He has been invited as guest surgeon for live surgery at several international urological meetings. During 15 years he was chairman of the Scandinavian Cooperative Group for Urinary Stones and he took the initiative to the Scandinavian Course on Urinary Stone Disease. In the period 2009-2013 he was Chairman of the EAU Section of Urolithiasis (EULIS), and he was president of the 2nd Meeting of EULIS in Copenhagen 2013. He has received several scientific awards, and he is and has been advisor for several Ph.D. students.

Prof. Osther is an honorary member of EAU Section of Urolithiasis (EULIS) and has been involved as reviewer in European Guidelines on Urolithiasis. He has been board member of the EAU Section Office, member of the Scientific Committees of Challenges in Endourology and Experts In Stone Disease. He chaired a sub-committee of the latest International Consultation on Stone Disease. Prof. Osther is member of the Editorial Board of several peer-reviewed journals.