The Research Of Mechanism And Management Of Ureteral Obstruction After Iatrogenic Ureteral Injury

Purpose:To establish a reliable animal mode of the ureteral injury and to screen the sensitive markers of the fibrotic process after the ureteral injury. Make clear the fluctuation characteristic of the different sensitive makers during the tissue scarring and evaluate the anti-fibrotic role of Captopril.Materials and methods:The New Zealand rabbit was taken to establish the animal model of ureteral injury. The EGF, TGF-β, FN, Col Ial, Col Ia2and Col III of the impaired ureter and the contralateral normal ureter were quantified by RT-PCR technique to find out the sensitive biomarkers of the ureteral fibrosis. The fluctuation of the markers during2to4weeks was also noted. A Captopril group and a control group were set to evaluate the anti-fibrotic efficacy of this medication in ureteral fibrosis. The Captopril10mg/Kg/d was given in experimental group while the placebo was given in control group. The specimens were harvest2weeks after the intervention and the RT-PCR was carried out.Result:The ureteral injury animal mode was established successfully. By RT-PCR screening, EGF, TGF-β, FN, Col Ial and Col Ia2were found to be significantly elevated than the other markers.(p<0.01) The peak level of EGF, TGF-β and Col Ial appeared at2weeks after the injury while for Fn and Col Ia2the peak level appeared at3weeks and4weeks after the surgery, respectively. For the Captopril experimentation, the expression of EGF, Fn and Col Ia2in Captopril group was significantly lower than control group. However, there was no statistic significance for TGF-B and Col Ial between the two groups.Conclusion:EGF, TGF-β, Col Ial, Col Ia2and FN seemed to have important role in the ureteral fibrosis and scarring after the ureteral lesion. The peak of the fibrosis was at2weeks after the injury. The Captopril might partially inhibit the fibrotic process by blocking the EGF, Col Ia2and FN pathway. Further research work should be carried out to clarify the ureteral fibrotic network, which may offer new clinical methods to prevent the ureteral scarring.