Feminizing genitoplasty.
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Adrenal Hyperplasia, Congenital↗
Biomedical subjects
G Passerini-Glazel
Publications and source records attributed to G Passerini-Glazel.
Guiding spontaneous tissue regeneration for urethral reconstruction: long-term studies in the rabbit.
We designed long-term in vivo experiments to study rabbit urethral regeneration and remodelling over a hyaluronan biodegradable prosthesis. Seven months after the resection of a 1.5-cm-long tract of the urethra and its substitution with the prosthesis, radiological analysis showed the disappearance of the implant and the re-establishment of urethral continuity along the transmural defect. The regenerated tissue remodelled around the implant and exhibited good distensibility under pressure. Histological evaluation showed that the neo-urethra was lined with transitional epithelium and the stroma contained abundant elastic fibres. An examination of the pattern of the major cytoskeletal and cytocontractile proteins of smooth muscle cells and fibroblasts was able to distinguish fibroblasts from smooth muscle cells and myofibroblasts in the neo-urethra. These experiments provide evidence for the potential, successful use of biocompatible/bioresorbable devices for reconstructive surgery of the urethra.
Actins↗
Time-dependent remodeling of the bladder wall in growing rabbits after partial outlet obstruction.
PURPOSE: We asked whether a urethral constriction gradually developed during growth would give rise to a structural remodeling of the bladder wall distinct from that of the mature rabbits in terms of cellular response. MATERIALS AND METHODS: We examined the serosa and detrusor muscle in immature rabbits whose urethra was obstructed at 30 days postnatal and studied 7 to 30 days after partial outlet obstruction. Morphometry, bromo-deoxyuridine (BrdU) incorporation, Western blotting and immunocytochemical staining with a panel of monoclonal antibodies specific to selected cytoskeletal, cytocontractile and membrane-related proteins unique to non-muscle and smooth muscle cells (SMC) were used to analyze the effects of obstruction on the differentiation pattern. RESULTS: In comparison with results in adult obstructed bladders, we have found that in growing rabbits: (1) the cell conversion from fibroblasts to SMC, occurring within the 'extrinsic' region of serosal thickening, takes place earlier; (2) newly formed SMC are localized exclusively to the thickened serosa, and can group in bundles depending on the density of the regional innervation; (3) the peak level of BrdU incorporation is more elevated than in the adult bladder wall; and (4) change in the phenotypic profile of SMC of detrusor muscle is delayed. CONCLUSION: These data indicate that the basic features of structural remodeling in the two models are similar, though partial outlet obstruction produced in growing animals accelerates the fibroblast conversion to SMC and their spatial, differentiation-specific arrangement in the serosa. The late phenotypic changes in obstructed detrusor muscle correlate with the decline of the DNA synthesis level after an initial burst and strongly suggest that newly formed SMC in the serosa do not derive from pre-existing SMC.
Animals↗
Proliferation of submesothelial mesenchymal cells during early phase of serosal thickening in the rabbit bladder is accompanied by transient keratin 18 expression.
Partial outlet obstruction of the rabbit bladder induces serosal thickening and smooth muscle (SM) hypertrophy. Within thickened serosa, submesothelial (mesenchymal) cells differentiate into SM cells after 30 days of obstruction[S. Buoro et al. Lab. Invest. 69, 589-602, 1993]. Here, we show that submesothelial cells transiently express keratin (K) 18 but not K8 soon after obstruction. We investigated a possible relationship between keratin expression and cell proliferation/differentiation in vivo and in vitro. The results of this study indicate that expression of K18 is spatiotemporally related to the pattern of cell proliferation with respect to the localization of an elastic membrane which divides the thickened serosa into an "extrinsic" and an "intrinsic" region. Moreover, K18 is not present in bladder mesenchyma during early development, indicating that its expression in the adult is not attributable to a dedifferentiation process. However, simultaneous K18, K8, and desmoplakin (DP) expression can be induced in normal and thickened serosa upon treatment with bromo-deoxyuridine. Our results indicate that K18 is a marker of proliferating mesenchymal cells in rabbit serosa, whereas the combined expression of K18, K8, and DP might be related to the hypothesized alterations in the stability of gene expression. A model is proposed in which keratin-containing submesothelial cells can act as a "transit" cell phenotype involved in both regenerating mesothelial cells and formation of SM cells.
Animals↗
Bellini duct carcinoma. A clinical and in vitro study.
OBJECTIVE: Bellini duct carcinoma (BDC) is a rare and highly aggressive renal tumor whose histogenesis is still a matter of debate although a putative origin from collecting ducts has been proposed. METHODS: A primary tumor cell culture was obtained from a BDC of a 57-year-old man who presented with a mass of the right kidney. The patient died from disease progression 18 months after diagnosis. The light and ultrastructural features were consistent with previous reports on BDC. The expression of low (Ker 18) and high (Ker 5, Ker 8, Ker 10) molecular weight keratins was studied. RESULTS: The BDC tumor cells displayed strong positivity for keratins, 5, 8 and 18 but did not react with the anti-keratin 10 antibody. Northern blot analysis of total mRNA revealed expression of the c-erbB-1 oncogene unlike two conventional clear cell carcinomas of the kidney used as control. Cytogenetic analysis revealed an aneuploid karyotype: 53,XY,del(1)(p34),+iso(1q),+iso(5p),+4,+7,+8,-14,del(16)(q22). No submicroscopic deletion on p14-21 and p26 regions of the short arm of chromosome 3 was detected on Southern blot analysis. CONCLUSIONS: The absence of structural changes in the short arm of chromosome 3 (usually present in hereditary and sporadic renal cell carcinomas) in the presence of chromosomal abnormalities observed in malignant lesions of urothelial origin confers to BDC a unique genetic profile among papillary tumors of the kidney.
Carcinoma, Papillary↗
Contractility and phenotype transitions in serosal thickening of obstructed rabbit bladder.
Partial outlet obstruction of rabbit bladder induces serosal thickening and smooth muscle (SM) cell hypertrophy that are accompanied by phenotypic changes in the expression of cytoskeletal and cytocontractile proteins. In the present study, we compare the observed progressive phenotypic changes with the contractile responses of strips of the thickened serosa. At 15 days after partial outlet obstruction, although cells in thickened serosa demonstrate the presence of nonmuscle (NM) myosin of A-like type, vimentin, and SM alpha-actin, no contractile responses of this tissue were noted. At later times (30 days), this tissue expressed in addition SM myosin, and this pattern was paralleled by the development of KCl-stimulated contractility. It is only after 60 days that the serosa demonstrated the expression of desmin, phosphoglucomutase (PGM)-related protein, and was locally negative for NM myosin, indicating a maturation toward adult SM cells. Concomitant to this phenotypic change, the response to KCl increased, and a bethanechol-stimulated contractile response developed. At no time period did the serosal layer react with anti-synaptophysin or anti-neurofilament proteins nor did the strips respond to field stimulation (via release of neurotransmitters), showing that SM cell differentiation and development of contractile responses during serosal thickening are independent of innervation.
Animals↗
Bladder dysfunction in children.
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Adolescent↗
Technical options in complex ureteral lesions: 'ureter-sparing' surgery.
From January 1979 to December 1992, 74 patients with ureteral lesions due to ureteral or renal instrumentations, failed gynecological or reconstructive surgery were addressed to our department for a reconstructive program. Fifty-two of them were managed by standard ureteropyeloanastomosis or psoas bladder hitch and ureteral reimplants. Twenty-two patients (12 females, 10 males, age range 28-68 years) suffered from extensive ureteral lesions (5-7 cm) and were managed by major ureteral reconstructive surgery intended to restore urothelial continuity. Three patients had a solitary kidney, and 6 cases suffered from bilateral ureteral injuries. The procedures employed were: psoas kidney hitch with ureteropelvic anastomosis (4 cases), kidney psoas bladder hitch (5 cases), 'extended' psoas bladder hitch (5 cases), transureterouretero-anastomosis+psoas bladder hitch (5 cases), psoas kidney-bladder hitch and transureterouretero-anastomosis (1 case), renal autotransplantation (2 cases). Only 5 minor postoperative complications were observed and all patients but one had satisfactory results with a follow-up ranging from 6 to 84 months. The authors believe that the restoration of urothelial continuity is the best option compared to other technical solutions such as ileal replacement, or diversion and nephrectomy. Autotransplantation should be reserved for rare selected cases.
Adult↗
Cytoskeletal and cytocontractile protein composition of smooth muscle cells in developing and obstructed rabbit bladder.
The differentiation patterns of smooth muscle cells (SMC) in rabbit bladder during development and in the hypertrophic response to partial outflow obstruction induced in adult animals were evaluated by biochemical and immunochemical techniques and by using a panel of monoclonal antibodies specific for desmin, vimentin, alpha-actin of smooth muscle (SM) type, SM myosin, and nonmuscle (NM) myosin isoforms. Desmin and SM alpha-actin were homogeneously distributed in SMC of developing, adult, and obstructed bladders. Conversely, marked changes in the ratio and antigenicity of SM myosin isoforms were observed by SDS electrophoresis and Western blotting, respectively. In particular, the 205 K (SM1) isoform was down-regulated with development whereas the 200 K (SM2) isoform was up-regulated around 7 days after birth and down-regulated in the obstructed bladder. Vimentin was expressed in SMC of the fetal bladder and declined markedly during postnatal, physiological hypertrophy of SMC, which occurs concomitantly with diminution of DNA synthesis. This polypeptide became detectable, however, in SMC of obstructed bladders. The 196 K (NM) myosin isoform recognized by NM-A9 antibody, present only in endothelium of blood vessels and in mucosa of normal fetal and adult bladders, became expressed in detrusor muscle, when SMC underwent a process of pathological hypertrophy. The reexpression of vimentin and the de novo appearance of NM myosin isoform in hypertrophic bladders can be reversed when the tissue mass is reduced, such as in bladders after 1-month recovery from partial obstruction. Thus, a specific NM myosin isoform can be used as a marker of SMC hypertrophy in obstructed bladder. In addition, the combined use of anti-vimentin and NM-A9 antibodies can distinguish between SMC which are in the physiological or in the pathological condition of adaptive bladder hypertrophy.
Animals↗
Endoscopic incision of ureteroceles: intravesical versus ectopic.
A total of 51 children, mostly less than 2 years old, underwent endoscopic incision of ureteroceles as a primary form of treatment. In 73% no further surgery was required. Of the patients 19 were diagnosed by prenatal ultrasound, with a urinary tract infection the usual presenting symptom in the remainder. Of 27 intravesical cases endoscopic incision resulted in decompression of the ureterocele in 93%, with preservation of upper pole function in 96%, and secondary surgical procedures were required in 7%. Reflux was created in 18% and it persisted in 2 of 4 patients. Of 24 cases of ectopic (extravesical) ureteroceles incision resulted in decompression in 75%, with upper pole function preserved in 50%. Reflux was created in 47% and a secondary surgical procedure was performed in 50%. Preservation of upper pole function was significantly better for intravesical versus ectopic ureteroceles (p < 0.01), and the requirement for secondary surgical procedure was greater with ectopic ureteroceles (p < 0.01). Three patients had intermittent bladder outlet obstruction following the incision and required further surgery. The 2 different techniques for incision of intravesical and ectopic ureteroceles are described. The role of endoscopic incision in the overall management of ureteroceles is confirmed by this review, and the need for partial nephroureterectomy may diminish.
Adolescent↗
Myofibroblast-derived smooth muscle cells during remodelling of rabbit urinary bladder wall induced by partial outflow obstruction.
BACKGROUND: Fibrosis of serosa, along with smooth muscle (SM) cell hypertrophy, has been shown to occur in the rabbit bladder after partial outflow obstruction. Identification of cells involved in the serosal thickening can be of primary interest to elucidate the functional changes that this organ undergoes. EXPERIMENTAL DESIGN: Cytoskeletal protein composition of cells present in the thickened serosa at different times from the onset of obstruction (7, 15, 30 and 60 days) was evaluated. This was accomplished by means of a panel of monoclonal antibodies specific for a number of differentiation markers of mesenchymal cells (vimentin, desmin, alpha-actin of SM type, nonmuscle (NM) and SM myosins), and by immunocytochemical and immunochemical techniques. RESULTS: The immunocytochemical study revealed that cells in serosal thickening follow a two-step maturation process from pre-existing vimentin-positive cells. In the first time period (7 to 15 days of obstruction), these cells predominantly achieved an immunophenotype corresponding to that of a specific myofibroblast subtype (i.e., containing vimentin, NM myosin, and SM alpha-actin). After 30 days from the onset of obstruction, the cytoskeletal protein content of serosal cells, as also revealed by Western blotting experiments, shifted towards that of fetal-type SM cells (i.e., presence of vimentin, NM myosin, SM alpha-actin, and SM myosin isoforms). Distribution of vimentin, desmin, SM alpha-actin, and SM myosin in tissue culture as well as the ultrastructure in vivo very closely resembled that of SM cells. Bromodeoxyuridine incorporation studies indicated that cells accumulated in the serosa of obstructed bladders did not derive, at least initially, from SM cells of the detrusor muscle. CONCLUSIONS: These findings are consistent with the existence of a differentiation process in which resident mesenchymal cells of bladder serosa may transform to myofibroblasts and, subsequently, in fetal-type SM cells during experimental outflow obstruction.
Actins↗
Late development of pelviureteric junction obstruction (PUJO) in a girl with previously normal pyelogram: a case report.
A case of ureteropelvic junction obstruction in a girl with previously normal pyelogram is presented. The aetiology of this development is unclear but this report emphasizes the need for a close follow-up of patients with persistent flank pain even if the initial pyelograms are normal.
Child↗
Functional daytime incontinence: pharmacological treatment.
The basis for the treatment of functional daytime incontinence in children is the bladder regimen, i.e. to teach the children to void regularly by the clock. Drug treatment may be needed as an adjunct to the regimen in children with gross detrusor instability. There is no evidence from properly controlled studies that tricyclic antidepressants or anticholinergic drugs are of value for the child with daytime wetting. Terodiline is a new drug combining anticholinergic and calcium-blocking effects. In two randomized, double-blind studies of terodiline compared with placebo in children with urge incontinence (i.e. functional day wetting), continence improved significantly over placebo in the terodiline group. Only a few mild adverse reactions were noted. Children with symptomatic urinary tract infection and day wetting should receive chemotherapy, but covert bacteriuria should best be left untreated. There is no evidence that eradication of the bacteriuria improves continence. Instead, there is a great risk of symptomatic recurrence of the urinary tract infection after antibacterial treatment.
Butylamines↗
Video-urodynamic studies of minor voiding dysfunctions in children: an overview of 13 years' experience.
By the definition 'minor voiding dysfunctions' is understood children with a history of frequency, urgency, daytime wetting, squatting, and infrequent voiding, singly or in combination. Urinary tract infections (UTI) are often present but symptoms must also be present when the children are free of infection. The upper urinary tract is generally normal or has minor anomalies. Any evidence of infravesical obstruction, frank or occult neurogenic bladder, or emotional disturbances must be excluded. In this study we report 13 years' experience of video-urodynamic evaluation in children with minor voiding dysfunctions, with special reference to clinical information, morphofunctional correlations, relationship with recurrent UTI, vesico-ureteric reflux and dilatation of the upper urinary tract. According to our experience we estimate that about 60% of the patients evaluated in this study would not require a video-urodynamic evaluation today.
Child↗
Ambulatory urodynamics: preliminary experience with vesico-urethral holter in children.
Detrusor function was evaluated by vesico-urethral holter (VUH), a computerized recording system (Urodec 500), in 17 children with lower urinary tract dysfunction. Eight had neurogenic bladders, eight had minor voiding dysfunction, and one was incontinent after posterior urethral valve ablation. VUH was technically satisfactory in, and acceptable to, all patients. It was more accurate in evaluating the type of urinary tract dysfunction than conventional urodynamics in 25% of the male patients and in 32.5% of the female patients.
Adolescent↗
A new 1-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermaphrodites.
A new 1-stage procedure for clitorovaginoplasty in severely masculinized female pseudohermaphrodites is presented. The technique consists of clitoral reduction with preservation of the neurovascular supply to the glans and vaginal formation by joining the inverted penile skin and the divided distal "urethra" (urogenital sinus) to form a cylinder that is then inserted into the perineum and anastomosed to the true vagina. For high and small vaginas Monfort's transtrigonal approach is suggested. This operation, 4 of which have been performed to date, can be done at any age, and it offers excellent cosmetic and functional results.
Child, Preschool↗
[Ureteral perfusion test in the urodynamic evaluation of the upper urinary tract: critical review and case study].
The authors report on their clinical experience with the use of Whitaker test in 38 patients (27 men, 5 women; age 3 months-66 years). Clinical applications of ureteral pressure-flow test are extensively reviewed. A standardized method with simultaneous recording of bladder pressure and combined video-pressure-flow study are basic points to be considered in order to obtain more objective data.
Adolescent↗
The P.A.D.U.A. (progressive augmentation by dilating the urethra anterior) procedure for the treatment of severe urethral hypoplasia.
Eight boys with congenital urethral hypoplasia and atresia are described, including 5 with a patent urachus, 2 with an "H" type urethral perineal duplication and 1 with a rectovesical fistula. Of the boys 5 had the prune belly syndrome. The technique of gradual progressive indwelling soft catheter or stent dilation achieved excellent results in 6 boys. This technique is believed to offer the slow stimulus necessary for urethral dilation that is missing in boys with a patient urachus or urethral duplication. The remaining 2 boys were treated with more conventional techniques of urethrotomy or rapid urethral dilation. They eventually achieved a satisfactory result but after significant morbidity. This clinical experience serves to describe and demonstrate how the application of gradual progressive soft, small catheter or stent dilation of severe urethral hypoplasia and atresia results in a functionally normal urethra with minimal morbidity.
Child, Preschool↗