Polidocanol versus absolute alcohol as sclerosing substances in experimental animal model
DOI:
https://doi.org/10.18004/Keywords:
Sclerotherapy, polidocanol, alcohol, fetal therapy, Paraguay, VenezuelaAbstract
Introduction: Sclerosis is characterized by epithelial cell destruction with apoptosis, sterile inflammation, irreversible fibrosis and decreased tissue mass by retraction with subsequent obliteration of the lumen of the cysts and / or blood vessels. There are different sclerosing substances that can be used. Even so, clear guidelines have not yet been defined in the management of sclerosing substances. This can be considered as a minimally invasive and effective treatment. Objective: To determine the efficacy and safety of polidocanol versus absolute alcohol as sclerosing substances in an experimental model. Materials and Methods: The study was conducted with 34 rats, randomly distributed in 3 groups. Group A with 16 rats to which 1 ml of intravesical polidocanol was introduced. Group B with 16 rats to which 1 ml of intravesical absolute alcohol was introduced. Group C (control) with 2 rats without intervention. The 2 rats of the control group were sacrificed with halothane overdose. Also the rats of each experimental group, which were sacrificed in pairs, chosen at random, at 12, 24, 48, 72, 96 and 120 hours after application respectively. Then the anatomopathological study was carried out. The depth and extension of the sclerosis was verified and a score was awarded according to a previously designed numerical scale. The efficacy and safety of both substances were determined and compared depending on the extension and depth of the sclerosis according to the time of action with logistic regression and Fisher’s exact test. Results: Both substances showed similar effectiveness in producing sclerosis with retraction of the bladder wall in 100% of the cases after 24 hours of application. The polidocanol showed progressive biological action, finding a correlation between the time of action and the depth of the sclerosis by means of the logistic regression analysis with a correlation coefficient of 0.75 and a probability index of 0.00183 (p <0.05). Absolute alcohol produced immediate deep sclerosis, without correlation with the time of action, with a correlation coefficient of - 0.0465 with a probability index of 0.864 (p> 0.05). The safety of the substances was estimated according to the finding of transmural sclerosis and injury to close organs. In no case with polidocanol (0%) there was transmural passage or injury of close organs, while in 83.33% of cases of absolute alcohol, transmural sclerosis with lesion of adjacent organs occurred in 50% of the cases (Fisher’s Test p <0.0001 extremely significant). None of the 2 substances produced remote organ injuries. Conclusions: Both alcohol and polidocanol are effective in generating sclerosis. Sclerosis with polidocanol is safe because it is limited to the bladder. Sclerotherapy with alcohol does not appear to be safe because it generates transmural sclerosis and injury to contiguous organs. The dissemination of the substances through blood or lymphatic vessels with lesions of distant organs did not occur in any case and seems unlikely since the sclerosants produce the occlusion of these vessels.
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