Does treatment of bladder dysfunction prior to renal transplant improve outcome in patients with posterior urethral valves?

Abstract

Fourteen patients with posterior urethral valves and end-stage renal failure were urodynamically evaluated in order to identify and correct any bladder dysfunction before renal transplant. Of the 14 patients, during filling, six had normal bladder function, two had an over-distended bladder (one with instability), one had instability, four had poor compliance, and one had a very reduced bladder capacity. During the voiding phase, one had a myogenic failure and another had detrusor-sphincteric dyssynergia. Four patients underwent bladder augmentation. Three were managed with anticholinergic therapy and two required clean intermittent catheterization owing to post-voiding residual urine. A renal transplant was performed in all of these patients at a mean age of 8.2 years. We compared outcome in these 14 patients with bladder dysfunction treated before transplantation with outcome in a matched control group of 14 transplant patients. Graft function and survival were similar in both groups. We believe that urodynamic studies must be included in the pretransplant evaluation of patients with posterior urethral valves in order to diagnose any bladder dysfunction and commence appropriate treatment to avoid any negative influence on graft function.

Increased Urologic Complications in Children After Kidney Transplants for Obstructive and Reflux Uropathy

“…Similar to previous studies, we found no significant difference in graft and patient survival rates between study patients and controls (3,5,6,8,9,16,21,32,33). Our 93% and 79% graft survival rates at 1 and 5 years posttransplant compare favorably with the 91% and 80% for LD KTx recipients as well as the 83% and 65% for deceased donor (DD) KTx recipients reported by the NAPRTCS (34).…”

“…Decreased graft function was reported for children with ESRD due to obstructive and reflux uropathy who underwent a KTx in the pre-cyclosporine (CSA) era (3). Reports of children with obstructive uropathy who underwent a KTx in the CSA era have been limited by small numbers of study patients, short follow-up periods, or lack of control patients (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). We report long-term KTx outcomes in a large group of children with ESRD due to obstructive and reflux uropathy who received maintenance immunosuppression with CSA.…”

Bladder dysfunction in children and adolescents after renal transplantation

“…This change is probably due to more knowledge about how to improve urine storage and bladder emptying in these patients, a view supported by Salomon et al's study in which boys with PUV and symptoms of a voiding dysfunction had a poorer graft function than those without such symptoms [17]. In another study in which bladder dysfunction was treated with bladder augmentation, anticholinergics or clean intermittent catheterization before the transplantation, no difference in renal function was found between boys with PUV and controls after transplantation [18].…”

“…Symptoms of bladder dysfunction after renal transplantation have been reported in adults [10]. There are several reports on post-transplant patient and graft survival [11][12][13][14][15][16] and a few on bladder function [17,18] in children with dysfunctional urinary tract, but there are, to our knowledge, no reports on bladder function in post-transplant children with normal urinary tracts. We report here the incidence of bladder dysfunction in an unselected group of renal transplant recipients in the Children's Hospital at Karolinska University Hospital, Huddinge, Sweden.…”

Is Bladder Cycling Useful in the Urodynamic Evaluation previous to Renal Transplantation?

“…If the native kidneys were damaged due to LUT abnormality, transplantation into the same bladder can be done only if there is evidence that it is a suitable site to drain the transplanted kidney [7,8] . Good results have been reported for RT done into abnormal bladders, provided that the dysfunctions had been detected and corrected prior to RT [9][10][11] . Other authors reported a relation between high bladder pressure during the UI and the loss of function of the graft in the follow-up [12] .…”