CORRECTION OF VESICOURETERAL REFLUX BY SUBURETERIC FIBRIN INJECTION IN DOGS

Objective To study the histological and radiological potential of the biomaterial fibrin in the treatment of vesico-ureteric reflux by a sub ureteric injection. Materials and methods For histological studies the bladders of 22 non-refluxing adult female dogs were exposed and in 20 of these two-component fibrin glue was injected into the right subure teric intramuscular portion of the bladder and teflon was injected int o the lamina propria of the left ureter; two of them acted as controls . Two dogs were killed on alternate days over the course of 21 post-op erative days and the bladders and distal portions of the meters were e xamined histologically, For radiological studies micturating cystogram s were obtained from 15 female puppies. In only eight puppies was vesi co-ureteric reflux naturally present. In six of these two-component fi brin was injected into the right and tenon into the left subureteric a reas, and in two puppies fibrin was injected into the subureteric area s, while the left sides acted as controls. Micturating cystograms and intravenous urograms were obtained from all puppies 3 weeks post-opera tively. Results Histopathological studies showed persistence of increa sed amounts of endogenous collagen at the fibrin-injected sites; at th e Teflon-injected sites a mass surrounded by dense granulation tissue was seen. Radiological studies revealed complete disappearance of refl ux in the study group of six fibrin and Teflon-injected puppies; in tw o control puppies fibrin was injected into the right subureteric area only; the left sides were left untouched to show that maturation did n ot play a role in abolishing the spontaneously occurring reflux. Follo w-up intravenous urography showed no evidence of vesico-ureteric obstr uction in the treated ureters. Conclusion Fibrin has the properties of a substance inducing a controlled increase in the number of endogenou s collagen fibres.