Study of post operative outcome in pediatric Pelviureteric junction obstruction and role of interstitial cells of Cajal

Introduction: The region of Pelviureteric junction has an innervations pattern with presence of interstitial cells of Cajal, the distribution of which has a bearing at the ultimate postoperative outcome. Aim is to study the post-operative outcome in congenital Pelviureteric junction obstruction by biochemical, radiological and radionuclide study and to correlate the presence and density of interstitial cells of Cajal as a predictive prognostic factor in congenital Pelviureteric junction obstruction. Materials and Methods: Specimens obtained following Anderson-Hynes pyeloplasty from 20 patients with intrinsic Pelviureteric junction obstruction were evaluated histopathologically and presence of interstitial cells of cajal were compared in good and poor outcome groups of patients. Cajal cells between the muscle layers stained with CD117 were enumerated per HPF and evaluated as follows: n = 0-1 (–); n = 2-5 (+); n = 6-10 (++); n = ≥ 11 (+++). ResultSixteen patients were obstruction free and were classified as Group I. Four patients did not improve and they were placed in Group II. All the patients with a poor outcome had negative grading at the PUJ and p-value was 0.002 which is significant. ConclusionThis study shows that altered density of CD117 positive cells in PUJ obstruction have a role in the transmission failure of peristaltic waves & postoperative outcomes.