Ureteral replacement using small-intestinal submucosa and a collagen inhibitor in a porcine model

David A. Duchene, Lucas Jacomides, Kenneth Ogan, Guy Lindberg, D. Brooke Johnson, Margaret S Pearle, Jeffrey A Cadeddu

Research output: Contribution to journalArticle

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Abstract

Purpose: Small-intestinal submucosa (SIS) has been successful as an onlay graft in ureteral repair, but tubularized segment interposition of SIS has been unsuccessful. Our objective was to evaluate whether a type I collagen inhibitor, halofuginone, would prevent stricture formation in tubularized SIS interposition. Materials and Methods: We performed either laparoscopic partial ureteral excision followed by an SIS on-lay graft (N = 5) or complete laparoscopic ureteral excision followed by an SIS interposition graft (N = 7) in domestic pigs. Animals received either no (N = 3), low-dose (N = 5), or high-dose (N = 4) halofuginone. Animals had ureteral stenting for 2 weeks after surgery and were permitted to survive for 6 or 9 weeks. An intravenous urogram (IVU) was performed prior to sacrifice. Kidneys were examined grossly and histologically. Results: One animal that received an onlay graft died of an unrelated illness. The remaining four ureteral onlay animals, including one control and two low-dose and one high-dose pig, had grossly normal kidneys at harvest. The IVU was normal in the control and high-dose animal but showed delayed excretion with mild hydroureteronephrosis in the low-dose animals. Pathologic examination of the SIS site revealed circumferential reepithelialization with inflammation and mild fibrosis. All seven tubularized interposition graft kidneys demonstrated either severe hydroureteronephrosis (N = 5) or renal atrophy (N = 2), and all had complete obstruction on IVU. Pathologic examination revealed a stenotic ureteral lumen with extensive surrounding inflammation and fibrosis. Conclusions: An SIS onlay graft was successful in the porcine model of ureteral injury. Halofuginone, a type I collagen inhibitor, did not demonstrate a significant beneficial effect in this technique. Ureteral tubularized interpositions with SIS are unsuccessful and not improved by halofuginone.

Original languageEnglish (US)
Pages (from-to)507-511
Number of pages5
JournalJournal of Endourology
Volume18
Issue number5
DOIs
StatePublished - Jun 2004

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Inlays
Swine
Collagen
Transplants
Urography
Kidney
Collagen Type I
Fibrosis
Inflammation
Sus scrofa
Atrophy
Pathologic Constriction
halofuginone
Wounds and Injuries

ASJC Scopus subject areas

  • Urology

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Ureteral replacement using small-intestinal submucosa and a collagen inhibitor in a porcine model. / Duchene, David A.; Jacomides, Lucas; Ogan, Kenneth; Lindberg, Guy; Johnson, D. Brooke; Pearle, Margaret S; Cadeddu, Jeffrey A.

In: Journal of Endourology, Vol. 18, No. 5, 06.2004, p. 507-511.

Research output: Contribution to journalArticle

Duchene, David A. ; Jacomides, Lucas ; Ogan, Kenneth ; Lindberg, Guy ; Johnson, D. Brooke ; Pearle, Margaret S ; Cadeddu, Jeffrey A. / Ureteral replacement using small-intestinal submucosa and a collagen inhibitor in a porcine model. In: Journal of Endourology. 2004 ; Vol. 18, No. 5. pp. 507-511.
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AU - Duchene, David A.

AU - Jacomides, Lucas

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AU - Pearle, Margaret S

AU - Cadeddu, Jeffrey A

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