Enterocystoplasty and Renal Transplantation

Martñ, M. González; Castro, Serafín Novás; Castelo, L. Álvarez; Abal, Venancio Chantada; Rodriguez, John; Novo, J. Duarte

doi:10.1097/00005392-200102000-00009

Cited by 20 publications

(6 citation statements)

References 14 publications

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“…Those who advocate against augmenting first argue that there is an unacceptably greater risk of sepsis when the transplant is attached to an augmented ‘dry’ bladder, and that the augment pedicle is jeopardised at the time of transplantation [5–7]. However, most series tend to report good results for bladder augmentation before transplantation [8–17]. There are no previous paediatric studies comparing groups transplanted or augmented first although we are aware of only one other study in adults [18].…”

Section: Discussionmentioning

confidence: 99%

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Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

et al. 2007

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Paediatric urology can uncover the most complicated cases that require careful attention to management details. Authors from the UK present a retrospective review of their experience of children who had undergone both renal transplantation and bladder augmentation. They recommend that the bladder be reconstructed before renal transplantation, as it might protect the transplanted kidney, and specifically the transplanted ureter. OBJECTIVE To identify whether the order of performing transplant and bladder reconstruction operations in children who need both operations affects outcome of either operation. PATIENTS AND METHODS A retrospective case note review was performed of children identified from our database, who had undergone both renal transplantation and bladder augmentation between 1990 and 2005. RESULTS In all, 18 renal transplants (eight live‐related) were performed in 16 children with 10 transplants done after bladder augmentation and eight transplants done before augmentation. The median age at transplantation was 7.5 years and at augmentation was 7.0 years. The median interval between the operations was 33.5 months and the median follow‐up was 58.4 months after transplantation. Outcomes were compared between the two groups of patients: those who received their transplantation before bladder augmentation, and those who were transplanted after bladder augmentation. There was no difference between these groups in: the pre‐ transplant estimated glomerular filtration rate, inpatient stay after transplantation or after augmentation, and incidence of urinary tract infection in the 3 months after renal transplantation or after bladder augmentation. There was no statistical difference in renal allograft loss with one graft failure in the group who were augmented first, and four graft failures in the group who were transplanted first. However, it is of note that the single graft failure in the patient augmented first was due to renal artery thrombosis on the first day related to a double arterial anastomosis, whilst in the other group, three of the graft failures were in transplants that had initially been drained by ureterostomy. Three patients in the group transplanted first developed significant ureteric pathology, of which one developed graft failure. CONCLUSION Bladder reconstruction can be performed safely before transplantation; it does not increase complications and might better protect the renal graft and specifically the transplant ureter.

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Section: Discussionmentioning

confidence: 99%

“…However, although the patients in the present study have had very poor renal function, none has been oliguric and thus all have had a sufficient urine output to cycle and maintain their augmented bladder. Other groups operating on anuric patients report using washouts to reduce bacterial and mucus load [9,12].…”

Section: Discussionmentioning

confidence: 99%

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

et al. 2007

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“…Although urinary tract infections were frequent, they did not seem to affect the long-term function of the graft. 5,8 No urinary stones or chronic metabolic acidosis were observed in our patients.…”

Section: Discussionmentioning

confidence: 59%

“…As in most series, we performed bladder augmentation or an ileal conduit before the renal transplantation to decrease the risk of posttransplantation complications. 2,3,5,7,8 The most common cause of graft loss among our patients was immunologic. Although urinary tract infections were frequent, they did not seem to affect the long-term function of the graft.…”

Section: Discussionmentioning

confidence: 82%

Renal transplantation in patients with lower urinary tract dysfunction

Parada

Figueiredo

Mota

et al. 2003

Transplantation Proceedings

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“…Restoration of the urinary tract by urinary diversion, or augmentation enterocystoplasty should be also considered in patients with neurogenic bladder or in those with a contracted bladder (9, 10). …”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Renal Transplant Recipients that Underwent Urologic Surgery for de novo Disease Before and After Transplantation

et al. 2005

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The pre-transplantation goal of the urologist is the optimization of urinary tract condition. Therefore, urologic surgery may be needed before or after renal transplantation. We analyzed the results of urologic surgery performed because of de novo urologic diseases. Between January 1986 and January 2001, 281 patients underwent renal transplantation, and 23 urologic surgical procedures were performed on 21 transplant recipients before or after renal transplantation because of de novo urologic diseases. By review the major reasons for urologic surgery in recipients were polycystic kidney diseases, vesicoureteral reflux, and dysfunctional voiding disorders. Nineteen surgical corrective procedures were done average 2.9 months before transplantation. The mortality rate was 10.5%. Four patients underwent urologic surgery at an average 57.5 months after transplantation. We highlight the fact that patients with uremia are vulnerable to surgical complications, and conclude that more intensive long-term urologic follow-ups should be conducted on recipients.

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Enterocystoplasty and Renal Transplantation

Abstract: In our experience bladder augmentation is an acceptable method, although not exempt from complications, for patients with alterations to the lower urinary tract and who are candidates for renal transplantation.

Cited by 20 publications

References 14 publications

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children

Renal transplantation in patients with lower urinary tract dysfunction

Clinical Characteristics of Renal Transplant Recipients that Underwent Urologic Surgery for de novo Disease Before and After Transplantation

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