Kidney transplantation in abnormal bladder

Abstract

Structural urologic abnormalities resulting in dysfunctional lower urinary tract leading to end stage renal disease may constitute 15% patients in the adult population and up to 20-30% in the pediatric population. A patient with an abnormal bladder, who is approaching end stage renal disease, needs careful evaluation of the lower urinary tract to plan the most satisfactory technical approach to the transplant procedure. Past experience of different authors can give an insight into the management and outcome of these patients. This review revisits the current literature available on transplantation in abnormal bladder and summarizes the clinical approach towards handling this group of difficult transplant patients. We add on our experience as we discuss the various issues. The outcome of renal transplant in abnormal bladder is not adversely affected when done in a reconstructed bladder. Correct preoperative evaluation, certain technical modification during transplant and postoperative care is mandatory to avoid complications. Knowledge of the abnormal bladder should allow successful transplantation with good outcome.

Evaluation of Transplant Suitability in a Patient with Previous Colorectal Cancer and Subsequent Radiation Cystitis: Insights from a Complicated Case

“…Abnormal bladder is frequent in KT candidate and may represent up to 15% of patients which is a great surgical challenge when considering KT [ 11 ]. Initial bladder assessment with urodynamic testing is important for patients with suspected bladder or lower urinary tract dysfunction, as capacities below 100 ml or voiding pressures over 100 cm H20 predispose to transplant complications [ 11 ]. Urodynamic testing is, therefore, an important step to guide our transplant options and if pretransplant intervention on the bladder is indicated.…”

“…Using intestinal tissue to create a new urinary bladder, such as ileal conduit formation, was also ruled out because of the several previous abdominal surgeries and postradiation abdominal lesions which would make such a technique too difcult in our patient's case. Both techniques are comparable in terms of outcomes, and the choice of technique should be based on the patient's characteristics [10][11][12][13]. Te simpler surgical technique for cutaneous ureterostomy can make it the preferred technique in frail patients as it is less invasive [10][11][12][13].…”

Conservative management of hostile bladders with intravesical botulinum toxin for successful renal transplantation

“…However, these major surgical operations carry significant short-term and long-term complications including mucus production, bladder stones, electrolyte abnormalities and bladder perforation. 4 The advent of intravesical botulinum has provided an alternative non-surgical management option to improve bladder compliance when more conservative methods have failed.…”

Estado de la cuestión: bacteriuria asintomática e infección urinaria en pacientes con trasplante renal

“…Particularmente, se ha observado en estudios de cohorte que con el tiempo y el flujo urinario mejorado, las vejigas recuperan la función siempre que no haya cicatrización de la pared de la vejiga o pérdida de la función neurológica 27 . Errando et al observaron en el estudio urodinámico pretrasplante capacidades de vejiga pretrasplante de 15 cc aumentando a 300 cc a los seis meses después del trasplante; en este periodo de recuperación, la vejiga puede ser inestable e hiperactiva y experimentar mayores presiones de detrusor durante el llenado, predisponiendo a la frecuencia urinaria, urgencia y reflujo en el riñón trasplantado o sistemas nativos.…”