Endopyelotomy failure is associated with reduced urinary transforming growth factor-beta 1 levels in patients with upper urinary tract obstruction

Background and Purpose: We previously demonstrated that obstructed ureterop elvic junction (UPJ) segments from patients who had secondary pyeloplasty a fter endopyelotomy failure expressed transforming growth factor-beta1 (TGF- beta1) at levels significantly lower than patients who had primary pyelopla sty. In order to determine whether these differences in secreted TGF-beta1 are detectable preoperatively in the urine, the TGF-beta1 concentration of urine from patients undergoing endopyelotomy was determined and compared wi th that from subjects without urologic disease. Materials and Methods: Bladder and renal pelvic urine from the obstructed s ide was obtained from patients (N = 34) undergoing primary endopyelotomy fo r UPJ obstruction. Bladder urine was also obtained from sex-and age-matched patients (N = 26) having no evidence of urinary tract obstruction. The TGF -beta1 concentration was determined by ELISA and normalized to the creatini ne concentration. Results: The bladder urine TGF-beta1 concentration was significantly (P < 0 .02) higher in patients with UPJ obstruction (86.1 +/- 20.5 pg/mg of creati nine) than in those without obstruction (29.7 +/- 8.0 pg/mg creatinine). Th e TGF-beta1 concentration in the bladder urine of patients who underwent en dopyelotomy and later returned because of UPJ obstruction (25.7 +/- 12.3 pg /mg of creatinine; N = 6) was not significantly different from the value in unobstructed patients but was significantly lower (P < 0.01) than in patie nts for whom endopyelotomy was successful (100 +/- 24.29 pg/mg of creatinin e; N = 28). The renal pelvic urinary TGF-beta1 concentration was higher in patients for whom endopyelotomy was successful (772 +/- 490.1 pg/mg of crea tinine) than in patients who underwent endopyelotomy and later returned bec ause of UPJ obstruction (126.1 +/- 41.9 pg/mg of creatinine). Conclusions: These data suggest that preoperative concentration of TGF-beta 1 in the bladder urine of patients with UPJ obstruction who fail endopyelot omy is not significantly different from that in subjects with no urologic d isease and significantly lower than in those patients for whom endopyelotom y is successful. Thus, the preoperative bladder urine concentration of TGF- beta1 may assist in selecting patients for this operation, although further investigation is necessary.