Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar;31(3):307-313.
doi: 10.1089/end.2016.0773. Epub 2017 Jan 24.

Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model

Søren Kissow Lildal  1   2 , Rikke Nørregaard  3 , Kim Hovgaard Andreassen  1   2 , Frederikke Eichner Christiansen  1   2 , Helene Jung  1   2 , Malene Roland Pedersen  2   4 , Palle Jörn Sloth Osther  1   2
Affiliations

Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model

Søren Kissow Lildal et al. J Endourol. 2017 Mar.

Abstract

Objective: To examine the effect of ureteral access sheath (UAS) on the expression of the pro-inflammatory mediators cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) in the ureteral wall.

Material and methods: In 22 pigs an UAS was inserted and removed after 2 minutes on one side and 2 hours on the contralateral side. Postoperatively ureters were excised in vivo, and tissue samples from the distal (2 minutes/2 hours) and proximal ureter (2 minutes/2 hours) were snap-frozen before quantitative polymerase chain reaction analysis of COX-2 and TNF-α. Five unmanipulated ureteral units from other pigs served as the control group.

Results: Compared to controls COX-2 mRNA was significantly upregulated in all UAS treated ureteral groups. Similarly, TNF-α mRNA was upregulated in all groups except the 2-minute proximal ureteral group. Both COX-2 and TNF-α expression were significantly higher in the distal than in the proximal ureter in the UAS treated ureters. After UAS insertion for 2 minutes, expression levels in the distal ureter were increased 6.5- and 8-fold for COX-2 and TNF-α, respectively; and after 2 hours of UAS placement COX-2 and TNF-α mRNA expression levels were increased 9- and 9.5-fold, respectively.

Conclusion: The pro-inflammatory mediators COX-2 and TNF-α were significantly upregulated in the ureteral wall by the influence of UAS. These findings may have implications for postoperative pain, drainage, and complications.

Keywords: complications; cyclooxygenase-2; tumor necrosis factor-α; ureter; ureteral access sheath; ureteroscopy.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist.

Figures

<b>FIG. 1.</b>
FIG. 1.
Ureteral expression of COX-2 mRNA (arbitrary units). The depicted values are calculated group means according to Table 1. *p < 0.05 (0.05–0.0001) compared with controls. $p < 0.05 (0.05–0.0001) distal part of the ureter compared with the proximal part within each group. Short term = 2 minutes. COX-2 = cyclooxygenase-2.
<b>FIG. 2.</b>
FIG. 2.
Log-transformed values of the measured COX-2 mRNA expression normalized for β-actin (95% CI). *p < 0.05 (0.05–0.0001) compared with controls. $p < 0.05 (0.05–0.0001) distal part of the ureter compared with the proximal part within each group. Short term = 2 minutes. CI = confidence interval.
<b>FIG. 3.</b>
FIG. 3.
Ureteral expression of TNF-α mRNA (arbitrary units). The depicted values are calculated group means according to Table 2. *p < 0.05 (0.05–0.001) compared with controls. $p < 0.05 (0.05–0.005) distal part of the ureter compared with the proximal part within each group. Short term = 2 minutes. TNF-α = tumor necrosis factor-α.
<b>FIG. 4.</b>
FIG. 4.
Log-transformed values of the measured TNF-α mRNA expression normalized for β-actin (95% CI). $p < 0.05 (0.05–0.005) distal part of the ureter compared with the proximal part within each group. *p < 0.05 (0.05–0.001) compared with controls. Short term = 2 minutes.
See this image and copyright information in PMC

References

    1. Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004;18:33–36 - PubMed
    1. Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol 2001;165:789–793 - PubMed
    1. Kaplan AG, Lipkin ME, Scales CDJ, Preminger GM. Use of ureteral access sheaths in ureteroscopy. Nat Rev Urol 2016;13:135–140 - PubMed
    1. Monga M, Bhayani S, Landman J, Conradie M, Sundaram CP, Clayman RV. Ureteral access for upper urinary tract disease: The access sheath. J Endourol 2001;15:831–834 - PubMed
    1. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from the insertion of a ureteral access sheath during retrograde intra-renal surgery (RIRS). J Urol 2012;189:580–584 - PubMed

Substances

LinkOut - more resources