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Mariotto A, Cserni T, Marei Marei M, Tavakoli A, Goyal A. Bladder salvage in children with congenital lower urinary tract malformations undergoing renal transplant. J Pediatr Urol 2023:S1477-5131(23)00145-6. [PMID: 37188601 DOI: 10.1016/j.jpurol.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Patients with Congenital Lower Urinary Tract Malformations (CLUTM) have increased risk of post-transplant complications if bladder dysfunction is not addressed. Pretransplant assessment may be difficult if urinary diversion has been previously applied. In case of low capacity and/or low compliance and/or high-pressure overactive bladder, transplantation into a diverted or augmented system may be required. We hypothesised that a bladder optimization pathway may help identify potentially salvageable bladders and prevent unnecessary bladder diversion or augmentation. We propose a structured bladder optimisation and assessment programme for safe transplant and native bladder salvage. MATERIAL AND METHODS Data of 130 children who underwent renal transplant between 2007 and 2018 were retrospectively collected and analysed. All patients with CLUTM were assessed by urodynamic study. Bladder optimisation: Low compliance bladders were managed with anticholinergics and/or Botulinum toxin A (BtA) injections. Those who had urinary diversion for their pathology underwent a structured assessment and optimisation process with undiversion/anticholinergics/BtA/bladder cycling/Clean Intermittent Catheterisation (CIC)/Suprapubic catheter (SPC) as indicated. Details of medical and surgical management were collected (Figure 1). RESULTS Between 2007 and 2018, 130 renal transplants were done. Of these, 35 (27%) had associated CLUTM (PUV in 15, neurogenic bladder dysfunction in 16, other pathology in 4) which was managed in our centre. Ten patients needed initial diversion in the form of vesicostomy (2) or ureterostomy (8) to manage primary bladder dysfunction. The median age at transplant was 7.8 years (range 2.5-19.6). After bladder assessment and optimisation, a safe bladder was demonstrated in 5 of 10 with initial diversion leading to transplant into native bladder (without augmentation). Overall, of the 35 patients, 20 (57%) had transplant into native bladder, 11 patients had ileal conduits and 4 had bladder augmentation. Eight required help with drainage: three with CIC, four with Mitrofanoff, and one had reduction cystoplasty. CONCLUSION With a structured bladder optimisation and assessment programme, safe transplant and 57% native bladder salvage is achievable in children with CLUTM.
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Affiliation(s)
- Arianna Mariotto
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, UK.
| | - Tamas Cserni
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, UK
| | - Mahmoud Marei Marei
- Department of Paediatric Surgery, Cairo University, Faculty of Medicine, Cairo University Children's Hospitals, Cairo, Egypt
| | - Afshin Tavakoli
- The Manchester Renal Transplant Unit (RTU), Manchester University Hospitals Foundation Trust (MFT), Oxford Road, Manchester, M139WL, UK
| | - Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxfords Road, Manchester, M139WL, UK
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Long-term Outcome of Renal Transplantation in Patients with Congenital Lower Urinary Tract Malformations: A Multicenter Study. Transplantation 2020; 104:165-171. [DOI: 10.1097/tp.0000000000002746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Agrawal S, Agrawal RR, Wood HM. Establishing a Multidisciplinary Approach to the Management of Neurologic Disease Affecting the Urinary Tract. Urol Clin North Am 2017; 44:377-389. [PMID: 28716319 DOI: 10.1016/j.ucl.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurologic diseases often affect the urinary tract and may be congential or acquired. The progressive nature of many neurologic diseases necessitates routine surveillance and treatment with a multidisciplinary approach. Urologic treatments may interact with pharmacologic or procedural interventions planned by other specialists, mandating close coordination of care and communication among providers. Primary care and nursing often can serve as the quarterbacks of the multidisciplinary team by identifying when a slowly progressive condition warrants further investigation and management by specialists.
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Affiliation(s)
- Shree Agrawal
- Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, USA.
| | - Ravi R Agrawal
- Boston University, One Silber Way, Boston, MA 02215, USA
| | - Hadley M Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
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Mencarelli F, Marks SD. Non-viral infections in children after renal transplantation. Pediatr Nephrol 2012; 27:1465-76. [PMID: 22318475 PMCID: PMC3407356 DOI: 10.1007/s00467-011-2099-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 11/05/2011] [Accepted: 11/11/2011] [Indexed: 12/20/2022]
Abstract
Renal transplantation has long been recognised as the gold standard treatment for children with end-stage renal failure. There has been an improvement over the years in patient and renal allograft survival because of improved immunosuppression, surgical techniques and living kidney donation. Despite reduced acute allograft rejection rates, non-viral infections continue to be a serious complication for paediatric renal transplant recipients (RTR). The risk of infections in RTR is determined by the pre-transplantation immunisation status, post-transplant exposure to potential pathogens and the amount of immunosuppression. The greatest risk of life-threatening and Cytomegalovirus infections is during the first 6 months post-transplant owing to a high immunosuppressive burden. The potential sources of bacterial infections are donor derived, transplant medium fluid, peritoneal and haemodialysis catheter and transplant ureteric stent. Urinary tract infections are frequent in patients with lower urinary tract dysfunction and can result in renal allograft damage. This review outlines the incidence, timing, risk factors, prevention and treatment of non-viral infections in paediatric RTR by critically reviewing current immunosuppressive regimens, their risk-benefit ratio in order to optimise renal allograft survival with reduced rates of rejection and infectious complications.
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Affiliation(s)
- Francesca Mencarelli
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH England UK
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH England UK
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Sager C, Burek C, Durán V, Corbetta JP, Weller S, Paz E, López JC. Outcome of renal transplant in patients with abnormal urinary tract. Pediatr Surg Int 2011; 27:423-30. [PMID: 20809115 DOI: 10.1007/s00383-010-2704-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether surgical procedures of the lower urinary tract in patients with uropathies affect evolution of the graft in renal transplantation. METHODS 156 kidney transplantations were performed in 150 patients with end-stage renal failure due to urologic disorders. The patients were classified into three groups: A, patients who did not require surgery in the lower urinary tract; B, required surgery and preserved adequate bladder function, and C, required surgery due to vesical dysfunction. RESULTS Graft survival rates at 1 year were 93.38% in group A, 95.45% in group B and 93% in group C. Rates at 5 years post-transplantation were 82.45, 79.85 and 86.58% for each group, respectively (not significant). Complications were vesicoureteral stenosis: 2 in group A, 3 in B and 1 in C; vesicoureteral reflux: 1 in group A, 1 in B and 10 in C; distal ureteral necrosis: 2 cases in group A, 2 in B and 1 in C; upper urinary tract infection: 12, 23.1 and 42.2% in each group, respectively. CONCLUSION Children with reconstructed urinary tract may be good candidates for kidney transplantation despite the higher frequency of urinary infections. Thus, careful and strict post-surgical urologic follow-up is mandatory.
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Affiliation(s)
- Cristian Sager
- Urology Department, Hospital de Pediatría Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Lasaponara F, Pasquale G, Cucchiarale G, Ferrando U. Bladder Augmentation and Urinary Diversions in Kidney Transplants. Urologia 2009. [DOI: 10.1177/039156030907600208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is some controversy about the safety of kidney transplant in patients with augmented or diverted urinary system: they are considered higher risk recipients in view of increased technical problems and infective complications leading to pyelonephritis and graft loss. The ureter of a transplanted kidney should be anastomosed into a reservoir with an adequate capacity, with low bladder pressure, with good compliance, and efficient voluntary empting. Ileal and sigmoid bladder augmentation, usually associated with clean intermittent catheterization, has become a well-accepted part of the urological practice and has been used for implantation of the transplant ureter. During the last years, the interest in new biomaterials for reconstructive surgery has increased. Experimental studies showed how these requests can be satisfied by porcine small intestinal submucosa SIS (Stratasis”): this can be degraded by the host and substituted by “new tissue”. In four recent cases we have used SIS to obtain an augmented, normal-pressure and good compliance bladder reservoir, with three (epithelial, muscular and adventitial) layers normally represented.
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Affiliation(s)
- F. Lasaponara
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - G. Pasquale
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - G. Cucchiarale
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
| | - U. Ferrando
- SC di Urologia 3, Dipartimento di Nefro-Urologia; ASO Molinette, Torino
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Rees L. Long-term outcome after renal transplantation in childhood. Pediatr Nephrol 2009; 24:475-84. [PMID: 17687572 PMCID: PMC2755795 DOI: 10.1007/s00467-007-0559-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/19/2007] [Accepted: 06/19/2007] [Indexed: 10/27/2022]
Abstract
The purpose of this article is to review: 1. Factors influencing long-term outcome data after transplantation 2. Patient survival overall, the effect of recipient age and donor type, causes of death, comparison of mortality after transplantation with that on dialysis, and effect of pre-emptive transplantation and race 3. Transplant survival overall, and the effect of recipient and donor age, donor type, pre-emptive transplantation, recurrent diseases, human leukocyte antigen (HLA) matching, immunosuppression, concordance, hypertension, bladder dynamics and type of donor nephrectomy 4. Final height and obesity 5. Psycho-social outcome.
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Affiliation(s)
- Lesley Rees
- Department of Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Basiri A, Otookesh H, Hosseini R, Simforoosh N, Moghaddam SMH. Kidney transplantation before or after augmentation cystoplasty in children with high-pressure neurogenic bladder. BJU Int 2008; 103:86-8; discussion 88. [PMID: 19016691 DOI: 10.1111/j.1464-410x.2008.08081.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the outcome and complications of augmentation cystoplasty before or after renal transplantation in children with neurogenic bladders, with those after kidney transplantation in children with normal bladders. PATIENTS AND METHODS Augmentation cystoplasty preceded transplantation in 21 children (group 1) and after transplantation in 23 (group 2) operated from 1985 to 2006; these two groups were compared with a control group of 45 children with a normal bladder (group 3) who also received a transplant, for kidney function, episodes of urinary tract infection (UTI), surgical and medical complications. RESULTS The mean age of the three groups was 12.9, 13.2 and 13.6 years, respectively (P = 0.2). Graft survival at 1, 3, 5 and 7 years was 90%, 76%, 65% and 43% in group 1, 94%, 61%, 50% and 40% in group 2, and 94%, 87%, 81% and 75% in group 3, respectively, which was not significantly different between groups 1 and 2, but was higher in group 3 (P = 0.03). Febrile UTI was reported in five (24%), seven (30%) and one (2%) patients in groups 1-3, respectively. UTI was significantly less frequent in group 3 (P = 0.01) but was not different between groups 1 and 2. Acute rejection was reported in nine (43%), nine (39%) and 15 (33%) patients in groups 1-3, respectively (P = 0.2). CONCLUSION The timing of cystoplasty in relation to transplantation has no apparent significant effect on the outcome of transplantation.
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Affiliation(s)
- Abbas Basiri
- Urology, UNRC, Shahid Beheshti University, MC, Tehran, Republic of Iran.
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Comparison of renal transplantation outcomes in children with and without bladder dysfunction. A customized approach equals the difference. J Urol 2007; 179:712-6. [PMID: 18082203 DOI: 10.1016/j.juro.2007.09.094] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE We examined the development of urological abnormalities in a group of pediatric renal transplant recipients. MATERIALS AND METHODS We reviewed 211 patients younger than 19 years who underwent 226 renal transplants. Three groups of patients were studied-136 children with end stage renal disease due to a nonurological cause (group 1), 56 children with a urological disorder but with an adequate bladder (group 2a) and 19 children with lower urinary tract dysfunction and/or inadequate bladder drainage (group 2b). A total of 15 children in group 2b underwent bladder augmentation (ureterocystoplasty in 6, enterocystoplasty in 9), 2 underwent continent urinary diversion, 1 underwent autoaugmentation and 1 underwent a Mitrofanoff procedure at the bladder for easier drainage. Kidney transplantation was performed in the classic manner by extraperitoneal access, and whenever possible the ureter was reimplanted using an antireflux procedure. RESULTS At a mean followup of 75 months 13 children had died, 59 grafts were lost and 15 children had received a second transplant. Two patients in group 2a required a complementary urological procedure to preserve renal function (1 enterocystoplasty, 1 vesicostomy). A total of 12 major surgical complications occurred in 226 kidney transplants (5.3%), with a similar incidence in all groups. The overall graft survival at 5 years was 75%, 74% and 84%, respectively, in groups 1, 2a and 2b. CONCLUSIONS With individualized treatment children with severely inferior lower urinary tract function may undergo renal transplantation with a safe and adequate outcome.
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Ruiz E, Ferraris J. 25 years of live related renal transplantation in children: The Buenos Aires experience. Indian J Urol 2007; 23:443-51. [PMID: 19718302 PMCID: PMC2721578 DOI: 10.4103/0970-1591.36720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The number of pediatric patients with end stage renal disease (ESRD) has been steadily growing during the last 10 years all over the world, because of the improvement of medical and surgical treatment of severe urologic malformations and congenital and acquired nephrological disorders. Kidney transplantation (Tx) with a live related donor continues to be the gold standard therapy to treat ESRD in children because of the best final results, the chronic lack of cadaveric donors and the frequent possibility of young patients to have parents or relatives as a source of a potential graft donor.Nowadays almost every pediatric patient can be dialyzed and transplanted, even early in life, if he or she has the possibility of a live related donor. Improvements in pediatric anesthesiology and intensive care have also been very important, in reducing the morbidity and mortality related to Tx procedures.Here we report our experience with Tx for the last 25 years, specially our long experience of live related donor transplantation in children and adolescents with emphasis on technical issues in small children and pediatric patients with severe urologic malformations and bladder dysfunction. We'll make special considerations on the improvement in short and long follow-up with the actual prevention and treatment of graft rejection, due to the new immunosuppressive agents and protocols.
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Affiliation(s)
- Eduardo Ruiz
- Section of Pediatric Urology, Service of Pediatric Surgery, Service of Pediatric Nephrology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina
| | - Jorge Ferraris
- Section of Pediatric Urology, Service of Pediatric Surgery, Service of Pediatric Nephrology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Argentina
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Ojogho ON, Ben-Youssef R, Chen LJ, Baron PW, Franco ES, Baldwin DD. Simultaneous pediatric kidney transplantation and ureterocystoplasty in a 20-month-old boy. Pediatr Transplant 2007; 11:436-40. [PMID: 17493227 DOI: 10.1111/j.1399-3046.2007.00696.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kidney transplantation (KT) in children with end-stage renal disease and an abnormal bladder poses a complex management challenge. Ureterocystoplasty (UC) has been previously reported in older children with non-compliant bladders, but the timing and technique of repair are controversial. This case reports the youngest patient, a 20-month-old boy to undergo successful single-stage UC and living-related KT. UC was performed because of a fibrotic, non-compliant bladder. A temporary vesicostomy was placed to provide adequate drainage in the presence of urethral stenosis. The patient developed a single episode of pyelonephritis within the first six months post-operatively, but there were no other urologic complications. At 13 months, the renal function is excellent with a mean glomerular filtration rate of 100 mL/min/1.73 m(2) and no clinical evidence of rejection. This case demonstrates that simultaneous UC and KT can be safely performed even in infants with non-compliant bladders and renal failure.
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Affiliation(s)
- O N Ojogho
- Transplantation Institute, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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Grapin-Dagorno C, Boubnova J, Ulinski T, Audry G, Bensman A. Transplantation rénale chez l’enfant porteur d’une anomalie du bas appareil urinaire. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2007. [DOI: 10.1016/s0001-4079(19)33045-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Solid organ transplantation, which began in adults in the 1950s, was extended to the pediatric population in the mid 1960s. Advances in immunosuppression and in surgical and medical skills have led to improving results in all types of organ transplantation. This success has now created many dilemmas especially in pediatric transplantation. In a field where the demands are high and resources limited, the distribution and allocation of resources becomes difficult. Complex decisions must be made with respect to who should be transplanted, when the transplant should occur, and where it should be performed. Of particular concern is the use of powerful immunosuppressive agents that may affect renal function and equally compromise patient's health with the potential for infection and malignancy. The various side effects of immunosuppressive agents may also cause difficulties in management. Decisions whether to retransplant habitual noncompliers are difficult. Diseases such as focal sclerosis and oxalosis, which recur in transplants, may affect decisions in selecting suitable recipients. The skills, experience, and resources of various multidisciplinary teams who manage these patients are often stretched to the utmost in their endeavors to achieve successful outcomes.
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Affiliation(s)
- O N Fernando
- Royal Free Hospital, Pond Street, London NW3 2QG, UK.
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Ruiz E, Cateriano JE, Lobos P, de Badiola FIP, Boer M, Moldes J, Puigdevall J, Ferraris J. Kidney transplantation in small children with live related donors: 20 years of experience. J Pediatr Urol 2006; 2:373-9. [PMID: 18947639 DOI: 10.1016/j.jpurol.2006.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 05/03/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Kidney transplantation (Tx) with a live related donor is the best option available for the treatment of end-stage renal disease at any age. Modern dialysis has allowed many very young and small children to receive a renal transplant with good results in spite of the limitations of space and the size of the adult kidney. Here, we report our experience with renal Tx with live related donors in this complex group of pediatric patients. MATERIAL AND METHODS From 1978 to 2004 a kidney transplantation was performed in 211 pediatric patients. Of this group, 23 patients between 1 and 10 years of age (16 males and seven females) of less than 17 kg (8.9-16.9 kg) received their first live related donor transplantation between 1985 and 2004. Renal insufficiency was secondary to nephropathy in 11 patients, infravesical obstruction in six and renal dysplasia or renal infarcts in six. RESULTS Patient and graft survival was 100% and 95.6% with an average follow up of 89.6 months (6-231). There were no vascular or urological complications. Urinary infection in five (21.7%) and acute rejection in three (13%) were the most common complications. One patient has returned to dialysis 11 years after Tx. CONCLUSIONS Young pediatric patients with a low body weight did not suffer a higher percentage of postoperative surgical complications, and the follow-up results are similar to those in older patients. A complex urological malformation has not prevented a living related Tx. These results encourage us to perform this procedure more frequently in younger patients when a live donor is available.
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Affiliation(s)
- Eduardo Ruiz
- Section of Pediatric Urology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Gascon 450, Buenos Aires (1181), Argentina.
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Otukesh H, Sharifian M, Simfroosh N, Basiri A, Hoseini R, Sedigh N, Golnari P, Rezai M, Fereshtenejad M. Outcome of renal transplantation in children with low urinary tract abnormality. Transplant Proc 2006; 37:3071-4. [PMID: 16213308 DOI: 10.1016/j.transproceed.2005.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with end-stage renal disease and lower urinary tract abnormality are often considered high risk for renal transplantation. METHODS AND SUBJECTS To examine the degree of risk, we studied patients who received renal transplants between 1985 and 2003. Forty eight patients had congenital lower urinary tract anomalies and 168 patients comprised a control group without these anomalies. RESULTS Mean age and distribution of sex were not significantly different between the case and the control group. Among patients with anomalies, 8% had delayed graft function; 75%, acute rejection; and 39.5%, chronic rejection. Among the controls 2.3% had delayed graft function; 59%, acute rejection; and 35%, chronic rejection. None of these differences was significant. Mean survival time was 6 years in affected patients and 7.3 years in the control group (P = .7). Among patients with anomalies the rate of graft survival in the first year after transplantation was 90%; and those in the third, fifth, and seventh years, 76%, 65%, and 40%, respectively. For the controls, the graft survivals were 88% at 1 year; 73% at 3 years; 70% at 5 years; and 49% at 7 years after transplantation. CONCLUSION This study showed that a history of lower urinary tract anomalies had no effect on graft function. Graft survival was not different among these patients compared with patients free of these anomalies.
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Affiliation(s)
- H Otukesh
- Labafi Nejad Hospital, Pasdaran Avenue, Tehran, Iran.
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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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Urodynamics Prior to Prostatectomy: Pro. J Urol 2004. [DOI: 10.1097/01.ju.0000145298.68666.f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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