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Antoniewicz AA, Zapała Ł, Bogucki A, Małecki R. The standard of urological consultation of patients qualified for renal transplant - a review. Cent European J Urol 2015; 68:376-82. [PMID: 26568885 PMCID: PMC4643699 DOI: 10.5173/ceju.2015.551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/26/2015] [Accepted: 06/23/2015] [Indexed: 11/22/2022] Open
Abstract
Urological consultation is an important step in the procedure of a patient's preparation before placing him/her on a waiting list for a renal transplant. Urological work-up aims to diagnose, treat, and optimize any preexisting urological disease. In the present paper we present the review of the literature together with the authors' conclusions based on literature and their experience. There is not enough data in current literature and urology manuals on the adequate sequence of the urological management with patients qualified for renal transplant and the literature needs an update. This study presents the crucial steps of the qualification and emphasizes the urge for a more standardized urological approach in patients qualified for a kidney transplantation.
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Affiliation(s)
| | - Łukasz Zapała
- Department of Urology, Multidisciplinary Hospital Warsaw-Międzylesie, Poland
| | - Arkadiusz Bogucki
- Department of Nephrology, Multidisciplinary Hospital Warsaw-Międzylesie, Poland
| | - Robert Małecki
- Department of Nephrology, Multidisciplinary Hospital Warsaw-Międzylesie, Poland
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Kocot A, Spahn M, Loeser A, Lopau K, Gerharz EW, Riedmiller H. Long-Term Results of a Staged Approach: Continent Urinary Diversion in Preparation for Renal Transplantation. J Urol 2010; 184:2038-42. [DOI: 10.1016/j.juro.2010.06.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Arkadius Kocot
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Martin Spahn
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Andreas Loeser
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Kai Lopau
- Department of Nephrology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Elmar W. Gerharz
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
| | - Hubertus Riedmiller
- Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany
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Challenges Facing Renal Transplantation in Pediatric Patients With Lower Urinary Tract Dysfunction. Transplantation 2010; 89:1299-1307. [DOI: 10.1097/tp.0b013e3181de5b8c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Chaykovska L, Deger S, Wille A, Friedersdorff F, Kasper A, Dragun D, Liefeldt L, Miller K, Giessing M, Fuller TF. Kidney Transplantation Into Urinary Conduits With Ureteroureterostomy Between Transplant and Native Ureter: Single-Center Experience. Urology 2009; 73:380-5. [PMID: 19022489 DOI: 10.1016/j.urology.2008.07.069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 07/24/2008] [Accepted: 07/29/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Lyubov Chaykovska
- Department of Urology, Charité University Hospital Campus Mitte, Berlin, Germany
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5
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Chmura A, Borkowski A, Radziszewski P, Kwiatkowski A, Rowiński W. Significance of Urodynamic Assessment of Lower Urinary Tract in Dialysis Patients Before Renal Transplantation. Transplant Proc 2007; 39:2733-5. [DOI: 10.1016/j.transproceed.2007.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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6
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Modi P. Pertinent issues in pretransplant recipient workup. Indian J Urol 2007; 23:278-85. [PMID: 19718331 PMCID: PMC2721607 DOI: 10.4103/0970-1591.33725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal transplantation is recognized as the treatment of choice in most patients with end-stage renal disease. The evaluation of the candidate for kidney transplantation has been the recent subject of clinical practice guidelines published by the European Renal Association- European Dialysis Transplant Association and the American Society of Transplantation. The purpose of this article is to review the current literature for urological evaluation and treatment of patients prior to renal transplantation. In India, urologists are involved in evaluating not only the genitourinary problems but also vascular access and, vascular anatomy and pathology especially related to major pelvic vessels. Hence, evaluation of the transplant recipient should include assessment of vascular access for hemodialysis, access for peritoneal dialysis, assessment of pelvic vessels to which renal allograft vessels need to be anastomosed and genitourinary system. In addition, review of the serological tests for infective viral diseases like hepatitis and human immunodeficiency viruses should always be done before starting clinical evaluation. A note of the evaluation performed by other specialists like nephrologist, cardiologist, endocrinologist, pulmonologist, anesthetist etc. should always be reviewed.
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Affiliation(s)
- Pranjal Modi
- Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad - 380 016, India
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7
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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.
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Affiliation(s)
- Shashi K. Mishra
- Department of Urology and Nephrology, Muljibhai Patel Society for Research in Nephrourology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat, India
| | - V. Muthu
- Department of Urology and Nephrology, Muljibhai Patel Society for Research in Nephrourology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat, India
| | - Mohan M. Rajapurkar
- Department of Urology and Nephrology, Muljibhai Patel Society for Research in Nephrourology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat, India
| | - Mahesh R. Desai
- Department of Urology and Nephrology, Muljibhai Patel Society for Research in Nephrourology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat, India
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Knoll G, Cockfield S, Blydt-Hansen T, Baran D, Kiberd B, Landsberg D, Rush D, Cole E. Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ 2005; 173:S1-25. [PMID: 16275956 PMCID: PMC1330435 DOI: 10.1503/cmaj.1041588] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Greg Knoll
- Division of Nephrology, The Ottawa Hospital, Ottawa, Ont.
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Tsai SY, Chang CYM, Piercey K, Kapoor A. TERMINAL LOOP CUTANEOUS URETEROSTOMY IN RENAL TRANSPLANTATION: AN UNDER UTILIZED URINARY DIVERSION TECHNIQUE. J Urol 2005; 174:1906-9; discussion 1909. [PMID: 16217339 DOI: 10.1097/01.ju.0000176749.86199.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We evaluated the effectiveness of terminal loop cutaneous ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. MATERIALS AND METHODS Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. RESULTS Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 mumol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. CONCLUSIONS Terminal loop cutaneous ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.
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Affiliation(s)
- Shian Yiu Tsai
- Division of Urology and Renal Transplantation, Department of Surgery, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada
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Ali-El-Dein B, Abol-Enein H, El-Husseini A, Osman Y, Shehab El-Din AB, Ghoneim MA. Renal transplantation in children with abnormal lower urinary tract. Transplant Proc 2005; 36:2968-73. [PMID: 15686672 DOI: 10.1016/j.transproceed.2004.11.095] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This retrospective study reports the outcomes as well as pre- and posttransplant urologic treatments of renal transplantation for children with an abnormal lower urinary tract (LUT). METHODS Between March 1981 and December 2001, 195 children (< or =18 years of age) received live-donor kidney transplants. The 15 recipients (14 boys and 1 girl, mean age 13.5 +/- 3 years) who had lower urinary tract disorders included posterior urethral valves (PUV) with valve bladder (n=12) and neuropathic bladders secondary to meningomyelocele (n=3). These children were evaluated by voiding cystourethrogram, cystourethroscopy, and cystometry. The children with PUV were maintained on clean intermittent catheterization (CIC) and a detrusor relaxant at least 3 months before transplantation. Augmentation ileocystoplasty or continent cutaneous diversion were used in three patients. The graft and patient survivals as well as complications in this cohort was compared with a group of children with normal LUT, who underwent renal transplantation during the same period. RESULTS One child died in the early posttransplant period due to rupture of the external iliac artery. Follow-up ranged from 6 months to 16 years (mean=4.5 years). During the same period the graft and patient survival rates were comparable between the group of children with versus without abnormal LUT. Furthermore, mean serum creatinine and creatinine clearance values were also comparable. The group with an abnormal LUT showed a higher incidence of urinary fistula (3/14) and recurrent UTI and/or bacteremia (4/14). CONCLUSIONS Renal transplantation is feasible with good results for children with abnormal LUT. Pre- and posttransplant urologic management is critical for a successful outcome. However these children display a high incidence of urologic and infectious complications.
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Affiliation(s)
- B Ali-El-Dein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Errando C, Batista JE, Caparros J, Araño P, Villavicencio H. Is Bladder Cycling Useful in the Urodynamic Evaluation previous to Renal Transplantation? Urol Int 2005; 74:341-5. [PMID: 15897701 DOI: 10.1159/000084435] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Accepted: 12/23/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the usefulness of bladder cycling (BC) in differentiating between urodynamic abnormalities due to reversible bladder dysfunction and those due to preexisting lower urinary tract (LUT) abnormalities, and to determine if BC increases the diagnostic yield of urodynamic investigations (UIs) in these patients. METHODS Eleven patients with oligoanuria (<300 ml/day) were evaluated with complete UIs. All cases showed low compliance (mean 6 ml/cm H2O) and low cystometric capacity (mean 146 ml) and were placed in a BC program. The indications for UIs were LUT symptoms in 2 patients, LUT abnormalities (myelodysplasia or urethral valves) in 3 patients, or the appearance of an extremely small bladder on cystogram (6 patients). BC was performed through a hypogastric catheter in an outpatient setting. UIs were repeated afterwards. RESULTS After BC, 5 patients (45%) continued to have low compliance (<8 ml/cm H2O) and 4 patients (36%) had normal UIs. In 2 cases (18%), a previously unrecognized obstruction was diagnosed. No patient with LUT symptoms or abnormalities had a normal UI after BC. Conversely, 4 of 6 patients in whom BC was indicated due to a small bladder on cystogram had normal UIs after BC. CONCLUSIONS BC is useful in explaining whether high bladder pressure is due to dysfunction or to preexisting disorders, and thus indicating the proper surgery for correction. Suprapubic BC significantly increases bladder capacity thus increasing the diagnostic yield of the UI.
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Abstract
In this article, we review the outcome and complications of renal transplantation in patients with reconstructed bladders and address specific issues and controversies regarding the management of such cases. Twenty-five articles covering the subjects of renal transplantation, lower urinary tract anomalies, and bladder reconstruction have been selected. Although urologic complications are higher when kidneys are transplanted into reconstructed bladders or urinary diversions, the graft and patient survival rates in most series are comparable with those transplanted into nonreconstructed bladders. The reported series of renal transplantation into abnormal bladders are small, and controlled studies are lacking. Bladder reconstruction should be performed before transplantation when clinically indicated.
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Affiliation(s)
- Julie Franc-Guimond
- Division of Pediatric Urology, Alfred I duPont Hospital for Children, Wilmington, DE 19899, USA
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Luke PPW, Herz DB, Bellinger MF, Chakrabarti P, Vivas CA, Scantlebury VP, Hakala TR, Jevnikar AM, Jain A, Shapiro R, Jordan ML. Long-term results of pediatric renal transplantation into a dysfunctional lower urinary tract. Transplantation 2003; 76:1578-82. [PMID: 14702527 DOI: 10.1097/01.tp.0000090866.00241.0c] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors reviewed their long-term experience with pediatric renal transplantation into a dysfunctional lower urinary tract to evaluate the results of contemporary lower urinary tract evaluation and management on graft survival and function. METHODS Between 1990 and 1996, 21 renal transplants were performed in 20 children with dysfunctional lower urinary tracts and 61 transplants were performed in 61 patients with normal lower urinary tracts. The minimum follow-up was 36 months (mean, 62.0 +/- 19.6 months). The cause of lower urinary tract dysfunction included posterior urethral valves (n=13), prune belly syndrome (n=4), meningomyelocele (n=2), and urogenital sinus abnormality (n=1). Urodynamics were performed on all children with dysfunctional lower urinary tracts. Using these perioperative assessments, lower tract management strategies were devised, including timed voiding alone (n=6), clean intermittent catheterization (n=8), bladder augmentation (n=4), and supravesical urinary diversion (n=2). RESULTS Overall 5-year actuarial patient and graft survival rates were 100% versus 95% (P=not significant [NS]) and 83% versus 69% in the dysfunctional and normal urinary tract groups (P=NS), respectively. Mean serum creatinine levels in dysfunctional and normal urinary tract patients with functioning grafts at 3 years were 1.3 +/- 0.5 and 1.3 +/- 0.7 mg/dL, respectively (P=NS). However, 35% of patients with a dysfunctional lower urinary tract experienced urologic complications. CONCLUSIONS Pediatric renal transplantation into a dysfunctional lower urinary tract yields outcomes comparable to transplantation into the normal lower urinary tract. Because of the high urologic complication rates, careful surveillance of lower urinary tract function by urodynamic evaluation is essential to optimize these outcomes.
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Affiliation(s)
- Patrick P W Luke
- Department of Urology, University of Pittsburgh Medical Center, Childrens Hospital of Pittsburgh, Pittsburgh, PA, USA.
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14
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15
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Affiliation(s)
- M E Sullivan
- Department of Urology, Churchill Hospital, Oxford, UK
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16
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17
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Al-Mousawi M, Samhan M, Ramesh S, Gupta R, Nampoory MR. Renal transplantation in patients with abnormal lower urinary tract. Transplant Proc 2001; 33:2676-7. [PMID: 11498119 DOI: 10.1016/s0041-1345(01)02144-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M Al-Mousawi
- Hamed Al-Essa Organ Transplant Center, Kuwait City, Kuwait
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Abstract
PURPOSE We report on our experience with renal transplantation in patients with severe chronic bladder contracture who underwent prior intestinal bladder augmentation, and assess the safety of the procedure. MATERIALS AND METHODS A total of 7 patients with severe alterations to the lower urinary tract and renal insufficiency underwent enterocystoplasty before renal transplantation. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in 4 cases, neurogenic bladder secondary to myelomeningocele in 1, chronic cystitis secondary to intravesical instillation of glutaraldehyde in 1 and hyperreflexic, contracted bladder in 1. Mean patient age was 38.4 years (range 19 to 57). The intestinal segment used was ileal conduit in 6 cases and an ileocaecal segment in 1. All 7 patients have received renal transplant from cadaveric donors. RESULTS Graft survival rate was 100% and graft function was good after a mean followup of 48 months (range 8 to 97). Of the patients 6 are continent and void spontaneously and 1 requires intermittent self-catheterization. CONCLUSIONS 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.
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Affiliation(s)
- M G Martín
- Department of Urology, Juan Canalejo Hospital, La Coruña, Spain
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Riedmiller H, Gerharz EW, Köhl U, Weingärtner K. Continent urinary diversion in preparation for renal transplantation: a staged approach. Transplantation 2000; 70:1713-7. [PMID: 11152102 DOI: 10.1097/00007890-200012270-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We prospectively assessed the safety of kidney transplantation into continent urinary intestinal reservoirs as a planned two-stage procedure in patients with absent or dysfunctional lower urinary tract. METHODS Between November 1990 and June 1999, 12 patients have undergone renal transplantation into continent urinary reservoirs, and a further patient with a diversion is awaiting transplantation. This was part of a larger series of 356 patients who had undergone continent diversions during that period. A further 174 patients (33%) had diversions into ileal conduits. FINDINGS Within a mean follow-up of 26.1 months (5-72) after transplantation renal function was stable with serum creatinine values ranging from 0.9 to 1.8 mg/dl. There were 5 reoperations in the 12 patients (40%). Two patients needed their continence mechanism replaced. One had renal vein thrombosis with loss of the transplant. The cause for this was unknown but it had been speculated that it could have been caused by graft/body size disproportion. A second kidney was successfully transplanted after 12 months. Two further revisions were required for ureteric kinking and lymphocele. The patient with orthotopic substitution voids to completion. The other patients are continent day and night with easy catheterization. INTERPRETATION This is one of the largest single series reported to date of renal transplantation into continent urinary diversions, and we commend the approach in carefully selected patients, but the difficulties must not be underestimated and the specific problems of intestinal urinary reservoirs have to be reckoned with. These procedures should be confined to centers with considerable experience with this type of surgery and its complications. Lifelong close surveillance is critical for the success of this concept.
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Affiliation(s)
- H Riedmiller
- Department of Urology, Julius Maximilians University Medical School, Würzburg, Germany.
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20
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Khudair WKAI, Mansi MK. Rehabilitation of long-term defunctionalized bladder for renal transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00836.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The continued success of renal transplantation has provided a higher quality of life for properly selected patients with ESRD. It is also a much more cost-effective and efficient treatment of ESRD compared with chronic dialysis. Innovative urologic reconstructive surgery using enteric segments for both continent and incontinent urinary diversions has permitted this therapeutic modality to be offered to the recipient with lower urinary tract disease not previously amenable to renal transplantation. These same reconstructive techniques using ileal segments have also permitted preservation of renal allografts with previously nonreconstructable renal pelvic or ureteral disease.
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Affiliation(s)
- M J Malone
- Department of Urology, Lahey Hitchcock Medical Center, Burlington, Massachusetts, USA
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22
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Ewalt DH, Allen TD. Urinary tract reconstruction in children undergoing renal transplantation. ADVANCES IN RENAL REPLACEMENT THERAPY 1996; 3:69-76. [PMID: 8620370 DOI: 10.1016/s1073-4449(96)80042-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In children, congenital urinary tract anomalies contribute to end-stage renal disease in 20% to 30% of cases. As more and more children with myelomeningocele, posterior urethral valves, prune belly syndrome, and other serious congenital anomalies of the urinary tract survive early infancy, more of these patients will be in need of renal transplantation. Of these, a significant proportion will have persisting abnormal anatomic and physiological characteristics of the urinary tract requiring reconstructive surgery before transplantation. Before undertaking these procedures, urologic evaluation should be performed in all such children. Comprehensive evaluation includes a careful history and physical examination with radiological imaging of the urinary tract (renal ultrasonography and voiding cystourethrography). In selected instances, further evaluation of bladder function and urethral anatomy may require urodynamic evaluation or cystourethroscopy. The goal of these investigations is to ensure that the bladder will hold urine at a low intravesical pressure during the storage phase and that it can be evacuated with certainty. This presentation focuses on the pretransplantation evaluation and the various possible urinary tract reconstructions that may be performed in children destined for renal transplantation.
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Affiliation(s)
- D H Ewalt
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
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Ross JH, Kay R, Novick AC, Hayes JM, Hodge EE, Streem SB. Long-term results of renal transplantation into the valve bladder. J Urol 1994; 151:1500-4. [PMID: 8189556 DOI: 10.1016/s0022-5347(17)35286-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between 1970 and 1990 renal transplantation was performed in 16 patients with a history of posterior urethral valves. While 10 patients had undergone supravesical urinary diversion before the development of end stage renal disease, all but 1 transplant were drained to the unaugmented native bladder. The 2 and 5-year graft survival rates were 70% and 59%, respectively. Of the 15 surviving patients 11 have allografts that are functioning at a mean of 86 months after transplantation with a mean serum creatinine of 2.0 mg./dl. Urological complications occurred in 19% of the transplants. No detrimental effect of the valve bladder on long-term allograft survival or function was apparent. With appropriate treatment of vesical dysfunction, these patients can be expected to have graft function comparable to the general transplant population despite use of the unaugmented native bladder.
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Affiliation(s)
- J H Ross
- Department of Urology, Cleveland Clinic Foundation, Ohio
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25
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Lucon AM, Sabbaga E, Ianhez LE, Chocair PR, Pestana JO, Arap S. Renal transplantation using external continent urinary diversion. J Urol 1994; 151:406-8. [PMID: 8283537 DOI: 10.1016/s0022-5347(17)34963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 29-year-old man born with bladder exstrophy presented with end stage renal failure many years after ileal conduit diversion. Bilateral nephrectomy and continent external urinary diversion were performed, and 1.5 months later a cadaveric kidney was grafted into the right iliac fossa. The patient was well at 18 months with a serum creatinine level of 1.2 mg./dl. and he was completely dry with 4 or 5 daily catheterizations. Although followup is still short, renal transplantation with drainage into an external continent urinary diversion permits excellent quality of life and good renal function. Therefore, this alternative is worth consideration whenever other reconstructive alternatives are not possible in candidates for renal transplantation.
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Affiliation(s)
- A M Lucon
- Division of Urology, São Paulo University Medical School, Brazil
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