Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation

Wagener, Nina; Adams, Judith E.; Gilfrich, Christian; Haferkamp, Axel; Pfitzenmaier, Jesco; Toenshoff, Burkhard; Schmidt, Jan; Hohenfellner, Markus

doi:10.1111/j.1464-410x.2008.08264.x

Cited by 37 publications

(18 citation statements)

References 26 publications

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“…It is also easy to introduce CIC posttransplant. 8,9 We mainly used an appendix as a conduit; however, we used an ileum with the spiral Yang-Monti channel method in one child. [11][12][13] Intravesical pressure should be controlled below approximately 35 to 40 cmH 2 O under administration of anticholinergic drugs and catheterization.…”

Section: Discussionmentioning

confidence: 99%

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Aikawa

Muramatsu²,

Takahashi³

et al. 2018

Exp Clin Transplant

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Lower urinary tract abnormalities are difficult to resolve in pediatric kidney transplant patients. Measure of residual urine, voiding cystourethrography, retrograde urethrography, cystometry, electromyography of urethral external sphincter muscle, urethrometry, and uroflowmetry are the primary methods for evaluation of lower urinary tract abnormalities. Endoscopic resection or ablation of urethral valves is required in children with posterior urethral valve to treat obstruction, but bladder function does not always recover and may deteriorate to end-stage renal failure even after the obstruction is released. This bladder dysfunction in posterior urethral valve defines valve bladder syndrome. Vesicoureteral reflux caused by high vesical pressure can cause even worse renal graft function posttransplant. In our patient group, urinary diversion occurred with Mitrofanoff conduit using an appendix in 6 children, a Yang-Monti channel conduit using ileum in 1 patient, with cystostomy in 3 children, and with augmented cystoplasty in 9 children before or simultaneously with kidney transplant. These procedures should be selected based on the type of lower urinary tract abnormality including bladder function. Recently, we have preferred a continent diversion for self-catheterization in children with lower urinary tract abnormalities. We have conducted 9 augmented cystoplasty procedures using a portion of the sigmoid colon or ileum. Seventeen children retained their own bladders when the transplant ureter was implanted. Most patients needed clean intermittent catheterization, depending on the residual urine volume and a bladder function. Ten-year graft survival rate in kidney transplant in our department is 98% in 36 children with lower urinary tract abnormalities. Lower urinary tract abnormality is not always a risk factor for pediatric kidney transplant; however, a preoperative evaluation is important to choose the best option for urinary diversion. Key words: Bladder function, Preoperative evaluation, Urinary diversion IntroductionLower urinary tract abnormalities (LUTAs) can be divided into 2 groups: neurogenic bladders and lower urinary tract anomalies. A neurogenic bladder is caused by spina bifida, 1 anal atresia, 2 spiral cord injury or tumor, or cerebral palsy. Prune belly syndrome, 3 persistent cloaca, 4 and posterior or anterior urethral valve 5-7 all involve lower urinary tract anomalies.Pretransplant evaluations of LUTAs are important, particularly for children with neurogenic bladders and those unable to void through a native urethra. In this situation, a diversion or a conduit should be considered.The Mitrofanoff conduit using an appendix is preferred to a simple diversion for kidney transplant. 8,9 It is easy for a parent or a child to manage the clean intermittent catheterization (CIC) required with the Mitrofanoff conduit. The Mitrofanoff conduit is advantageous for children because it can be kept dry and a urine storage bag is not required.An augmentation cystoplasty for a neurogenic bladder with ...

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Section: Discussionmentioning

confidence: 99%

“…8,9 It is easy for a parent or a child to manage the clean intermittent catheterization (CIC) required with the Mitrofanoff conduit. The Mitrofanoff conduit is advantageous for children because it can be kept dry and a urine storage bag is not required.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Aikawa

Muramatsu²,

Takahashi³

et al. 2018

Exp Clin Transplant

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“…According to most published reports, the current trend is to perform urinary diversion with an ileal or ileocecal segment before kidney transplantation [16,17,18]. One of the reasons is that immunosuppressive therapy after transplantation may adversely affect healing of the anastomosis site or incision [4,14,19].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Simultaneous or Staged Urinary Diversion and Kidney Transplantation

Teng

Wang²,

Li³

2013

Urol Int

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Objectives: We retrospectively analyzed the long-term outcomes of simultaneous or staged urinary diversion and kidney transplantation. Patients and Methods: Between June 2001 and December 2012, 4 patients with dysfunctional bladder resulting from spina bifida (n = 3) or bladder contraction following urologic tuberculosis (n = 1) underwent cadaveric kidney transplantation and urinary diversion simultaneously (n = 3) or 6 months post-transplantation (n = 1). Urinary diversion consisted of cutaneous ureterostomy in 1 patient and ileal conduits in 3 patients. All patients were followed prospectively. Results: All 4 patients received deceased donor transplants. Median follow-up was 110.5 months (range 50-120). At the last follow-up, serum creatinine levels ranged from 1.1 to 1.8 mg/dl. One patient with a functioning graft died of severe cirrhosis 105 months following transplantation. Graft function remained stable without any severe complications in 3 patients. Hematoma (Clavien-Dindo grade IIIa) and urinary leakage (grade II) occurred in 1 patient in the early postoperative period, but no surgical revision was required. Two patients developed cytomegalovirus pneumonia. Urinary tract infection was a common problem in all patients. Conclusions: For patients with lower urinary tract dysfunction, simultaneous kidney transplantation and urinary diversion with an ileal conduit may be a safe, feasible approach, with a satisfactory long-term outcome.

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“…However if there is no bladder or a lower urinary tract abnormality, KT can be performed into an ileal conduit, a bladder augmentation, an ureterocystoplasty or an orthotopic neobladder [9]. Some authors concluded that a two-stage procedure consisting of reconstruction of the lower urinary tract followed by renal transplantation is a safe and efficient approach which achieves similar results to those in transplanted patient with a normal lower urinary tract.…”

Section: The Vascular Contraindications Have Almost Disappearedmentioning

confidence: 99%

Are there still surgical limits to kidney transplantation?

Doerfler¹,

Tillou²

2015

UNOAJ

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Even if surgical complications are higher than in general population, overall survival in obese kidney recipients is better than in obese dialyzed patients with a body mass index up to 35 [2]. Moreover, third and fourth KT is becoming commonplace [3]. Surgical techniques are various in the literature. Some authors use a trans-peritoneal midline incision others use a retroperitoneal heterotopic approach. The overall surgical complications rate is about 25% without graft loss reported. Now we have come to fifth KT in patients whose life expectancy lengthens and in whom the progress of immunosuppression allows re-transplantation [4].

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Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation

Cited by 37 publications

References 26 publications

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Long-Term Outcome of Simultaneous or Staged Urinary Diversion and Kidney Transplantation

Are there still surgical limits to kidney transplantation?

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