Akademik Veri Yönetim Sistemi
JOURNAL OF PEDIATRIC SURGERY, cilt.60, sa.12, 2025 (SCI-Expanded, Scopus)
Introduction: The pathogenesis of ureteropelvic junction obstruction (UPJO) remains unclear, with both neuronal and connective tissue components implicated in its development. Understanding the histopathological mechanisms of UPJO is essential for optimizing treatment strategies and predicting disease progression. This study aimed to investigate age-related differences in neuronal function, synaptic activity, and connective tissue remodeling in pediatric and adult UPJO patients using immunohistochemical markers. Materials and methods: A total of 58 patients (29 pediatric and 29 adult) who underwent AndersonHynes dismembered pyeloplasty for UPJO between 2010 and 2023 were included in this study. Immunohistochemical staining was performed on tissue samples from paraffin-embedded blocks using S100 (neuronal marker), Synaptophysin (synaptic vesicle protein), and PDGFR-A (platelet-derived growth factor receptor alpha). Additionally, seven adult control samples were analyzed. Results: S100 staining was significantly higher in adult intrinsic UPJO cases compared to pediatric intrinsic cases (p = 0.039), adult extrinsic cases (p < 0.001), and the control group (p < 0.001), suggesting a chronic neuronal compensatory response in prolonged obstruction. In contrast, pediatric intrinsic and extrinsic UPJO cases exhibited significantly higher Synaptophysin staining than adult cases (p < 0.001), indicating an increased synaptic activity and neuronal plasticity in early life. No significant differences in PDGFR-A staining were observed among the groups, suggesting that fibrosis-related connective tissue remodeling may not play a primary role in UPJO pathogenesis. Conclusion: Our findings suggest that UPJO is associated with distinct neuronal adaptations in pediatric and adult patients. The increased neuronal density in adult intrinsic UPJO cases may reflect a chronic compensatory mechanism, while the higher synaptic activity in pediatric cases indicates a more dynamic neuronal response. The absence of significant connective tissue remodeling differences suggests that neural alterations may be the dominant pathological feature in UPJO. Future research should focus on the long-term implications of neuronal changes and evaluate potential neuroprotective approaches in UPJO management. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.