1
|
Osman Y, Zahran MH, Harraz AM, Mashaly M, Kamal AI, Ali-El-Dein B. Utility of Pre-Transplant Bladder Cycling for Patients With a Defunctionalized Bladder. A Randomized Controlled Trial. Urology 2023; 174:172-178. [PMID: 36682701 DOI: 10.1016/j.urology.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To study the necessity of pre-transplant programmed bladder cycling (PBC) in patients with defunctionalized bladder (DB). METHOD This RCT included renal transplant (RT) candidates with DB. Eligible patients were assigned to 2 groups, group I underwent PBC before RT and group II underwent direct RT into the DB. The primary outcome was to assess the efficacy of PBC in improving post- RT bladder capacity. Secondly, to compare its impact on early urological complications and 3-month voiding function and 1-year graft function and survival. Graft function was evaluated using serum creatinine and eGFR using MDRD equation. RESULTS Groups I included 23 patients and group II included 20 patients. The mean ±SD of bladder capacity was 88.7±11.7mL and 90.6 ±9.8mL in both groups, respectively (P = .5). In group I, PBC increased bladder capacity to 194.7 ±21.2 mL (P < .001). Targeted bladder capacity was achieved in 19 (82.6 %) patients and 2 patients developed UTI. At 3-months, bladder capacity, compliance and bladder contractility index improved significantly in both groups with a significant reduction in maximum detrusor pressure with no significant difference between both groups (P = .3,0.4, 0.2 and 0.8, respectively). Urinary leakage occurred in one (4.3%) and 3 patients (15%) in group 1 and 2, respectively (P = .2). At 1-year, no statistically significant differences in the median (IQR) serum creatinine (P = .05) and eGFR (P = .07) between both groups were noted. CONCLUSION Pre-transplant PBC for DB-patients provided no clinical advantage concerning post-operative urological complication, urodynamic criteria and graft function and survival.
Collapse
Affiliation(s)
- Yasser Osman
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed H Zahran
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed M Harraz
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Mashaly
- Nephrology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed I Kamal
- Nephrology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bedeir Ali-El-Dein
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
2
|
Gueguen J, Timsit M, Scemla A, Boutin J, Bruyere F, Longuet H, Sberro‐Soussan R, Legendre C, Anglicheau D, Büchler M. Outcomes of kidney‐transplanted patients with history of intestinal reconstruction of the urinary tract. BJUI COMPASS 2021; 3:75-85. [PMID: 35475156 PMCID: PMC8988834 DOI: 10.1002/bco2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/07/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Juliette Gueguen
- Department of Nephrology and Clinical Immunology Hospital of Tours Tours France
- Transplantation, Immunologie, Inflammation (T2I) University of Tours Tours France
| | - Marc‐Olivier Timsit
- Department of Urology and Renal Transplantation Georges Pompidou European Hospital, AP‐HP Paris France
- Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique‐Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France
| | - Anne Scemla
- Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique‐Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France
| | | | - Franck Bruyere
- Transplantation, Immunologie, Inflammation (T2I) University of Tours Tours France
- Department of Urology CHU de Tours Tours France
| | - Hélène Longuet
- Department of Nephrology and Clinical Immunology Hospital of Tours Tours France
| | - Rebecca Sberro‐Soussan
- Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique‐Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France
| | - Christophe Legendre
- Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique‐Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France
| | - Dany Anglicheau
- Paris Cite and Kidney Transplantation Department Necker Hospital, Assistance Publique‐Hôpitaux de Paris, Paris Descartes University Sorbonne Paris France
| | - Matthias Büchler
- Department of Nephrology and Clinical Immunology Hospital of Tours Tours France
- Transplantation, Immunologie, Inflammation (T2I) University of Tours Tours France
| |
Collapse
|
3
|
Deininger S, Nadalin S, Amend B, Guthoff M, Heyne N, Königsrainer A, Strohäker J, Stenzl A, Rausch S. Minimal-invasive management of urological complications after kidney transplantation. Int Urol Nephrol 2021; 53:1267-1277. [PMID: 33655463 PMCID: PMC8192401 DOI: 10.1007/s11255-021-02825-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Kidney transplantation represents the gold standard treatment option for patients with end-stage renal disease. Improvements in surgical technique and pharmacologic treatment have continuously prolonged allograft survival in recent years. However, urological complications are frequently observed, leading to both postoperative morbidity and putative deterioration of allograft function. While open redo surgery in these patients is often accompanied by elevated surgical risk, endoscopic management of urological complications is an alternative, minimal-invasive option. In the present article, we reviewed the literature on relevant urological postoperative complications after kidney transplantation and describe preventive approaches during the pre-transplantation assessment and their management using minimal-invasive approaches.
Collapse
Affiliation(s)
- Susanne Deininger
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Guthoff
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jens Strohäker
- Department of General and Transplant Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| |
Collapse
|
4
|
Barrera Lozano LM, Gutierrez Montoya JI, Henao Sierra JE. Ureterostomía cutánea como derivación urinaria definitiva en trasplante renal. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Cerca del 15 % de los pacientes con insuficiencia renal crónica terminal tienen alteraciones de las vías urinarias inferiores. Estas anomalías eran consideradas una contraindicación para el trasplante renal. Por lo anterior, el objetivo del presente trabajo es describir el comportamiento sociodemográfico y clínico de los pacientes trasplantados renales con ureterostomía cutánea como técnica de derivación definitiva de las vías urinarias. Métodos. Se realizó un estudio descriptivo, longitudinal y retrospectivo de los pacientes trasplantados renales con vejiga anormal y ureterostomía cutánea, entre enero de 1973 y octubre de 2012. Resultados. En 4.294 trasplantes renales, se practicaron 24 (0,55 %) ureterostomías, 19 (79,1 %) como técnica inicial y 5 por falla de la ureteroneocistostomía. Diez (41,7 %) ureterostomías fallaron, la mayoría (8 casos) por estenosis. Se presentó infección urinaria en 20 pacientes y la mortalidad fue del 8,3 % (2/24). El 50 % (12/24) de los pacientes con trasplante de riñón estuvieron libres de infección urinaria durante el primer año. La supervivencia del riñón trasplantado fue de 93,8 % (23/24) a los 18 meses, de 85,9 % (20/24) a los 36 meses y de 66,7 % (16/24) a los 50 meses de seguimiento. La supervivencia de los injertos con ureterostomía sin infección fue del 100 % durante el periodo de seguimiento, mientras que la supervivencia de los riñones con infección urinaria fue de 93 % (23/24) a los 18 meses, de 76 % (18/24) a los 36 meses y de 54 % (13/24) a los 50 meses (p=0,235). Conclusiones. La ureterostomía cutánea es una alternativa segura para la derivación urinaria en pacientes trasplantados renales con alteraciones de la vejiga que no permite su uso o preparación antes del trasplante.
Collapse
|
5
|
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]
|
6
|
Nierentransplantation in Harnableitungen. Urologe A 2019; 59:27-31. [DOI: 10.1007/s00120-019-01093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
Neves Neto JF, Palomino Z, Mizuno Watanabe IK, Aguiar WF, Medina-Pestana JO, Soler R. Pretransplant defunctionalized bladder-overrated condition? Neurourol Urodyn 2018; 37:1559-1566. [PMID: 29357104 DOI: 10.1002/nau.23495] [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] [Received: 11/20/2017] [Accepted: 12/19/2017] [Indexed: 11/11/2022]
Abstract
AIMS The objective of this study was to evaluate the expression of bladder receptors in patients with defunctionalized bladder (DB) and to assess voiding behavior after refunctionalization. METHODS A total of 68 pretransplant patients were divided in two groups: DB (diuresis <300 mL/24 h; n = 33) and NDB (non-DB; diuresis ≥300 mL/24 h; n = 35). A sample of mucosa and detrusor at the site of the future ureteral implantation was collected. The following receptors were assessed by real-time polymerase chain reaction (qRT-PCR): M2 , M3 , α1D , β3 , P2X2 , P2X3 , TRPV1, TRPV4, TRPA1, and TRPM8. At 3, 6, and 12 months after transplant patients answered IPSS and ICIQ-OAB questionnaires and filled a 3-day 24 h frequency/volume chart (FVC) at 6 and 12 months. RESULTS The expression of all receptors in the mucosa and in the detrusor was similar in both groups, except from α1D , which was overexpressed in the detrusor of DB relatively to NDB group. ICIQ-OAB symptom score was similar between the groups at 3, 6, and 12 months. There was a reduction of this score in both groups with time. The same pattern was found for IPSS score. Bother scores were similar between groups. No difference was observed for all FVC parameters between DB and NDB patients. CONCLUSION Gene expression of bladder receptors involved in micturition control was similar in patients with or without DB. Bladder behavior had a similar pattern independently of pretransplant residual diuresis. These findings question the relevance of the term DB in pretransplant patients.
Collapse
Affiliation(s)
- João F Neves Neto
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zaira Palomino
- Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Wilson F Aguiar
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose O Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, Brazil.,Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roberto Soler
- Division of Urology, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Renal Transplantation into a Diverted Urinary System—Is it Safe in Children? J Urol 2013; 190:678-82. [DOI: 10.1016/j.juro.2013.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/23/2022]
|
9
|
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]
|
10
|
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]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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]
|
13
|
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.
Collapse
|
14
|
Theodorou C, Katsifotis C, Bocos J, Moutzouris G, Stournaras P, Kostakis A. Urodynamics prior to renal transplantation--its impact on treatment decision and final results. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2004; 37:335-8. [PMID: 12944193 DOI: 10.1080/00365590310001674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the role of urodynamics prior to renal transplantation in a selected group of patients. MATERIAL AND METHODS This retrospective study included 44 consecutive patients (20 males, 24 females; age range 7-57 years; mean age 27.14 +/- 15.17 years) referred for urodynamic evaluation due to known or suspected lower urinary tract dysfunction. End-stage renal disease was due to obstructive uropathy in nine patients, reflux nephropathy in 13, neuropathic bladder in nine and various parenchymal diseases in four; in nine patients the origin of renal failure remained obscure despite detailed investigations. All the patients were subjected to detailed video-urodynamics. RESULTS In 30 patients (68.2%) a urodynamic abnormality was found which precluded kidney transplantation into their native bladders without major reconstruction, a minor corrective procedure and/or pharmacotherapy prior to transplantation. More specifically, seven patients were found to have infravesical obstruction, one had a small fibrotic bladder, seven had small capacity bladders due to long-term non-use, four were found on cystometry to have an idiopathic overactive detrusor and 11 exhibited evidence of neurogenic lower urinary tract dysfunction. Fourteen affected patients (32%) were subjected to treatment prior to kidney transplantation: three underwent bladder neck incision, seven recycling of their small bladders, one substitution and three augmentation cystoplasty. Kidney transplantation followed reconstruction 3-18 months later (mean 5 +/- 6.2 months). The follow-up ranged from 12 to 107 months (mean 25 +/- 21 months). CONCLUSION Urodynamics prior to kidney transplantation in this selected group of patients established a definitive diagnosis of the type of lower urinary tract dysfunction, offered the opportunity for reconstructive surgery and enabled kidney transplantation.
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Julie Franc-Guimond
- Division of Pediatric Urology, Alfred I duPont Hospital for Children, Wilmington, DE 19899, USA
| | | |
Collapse
|
16
|
Affiliation(s)
- M E Sullivan
- Department of Urology, Churchill Hospital, Oxford, UK
| | | | | |
Collapse
|
17
|
|
18
|
Bretan PN, Purohit RS. Successful long-term outcome utilizing existing native cutaneous ureterostomy for renal transplant drainage without ipsilateral native nephrectomy. Transplant Proc 2000; 32:771-2. [PMID: 10856578 DOI: 10.1016/s0041-1345(00)00977-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P N Bretan
- University of California, San Francisco, Departments of Urology and Surgery, Kidney Transplant Service, San Francisco, California, USA
| | | |
Collapse
|
19
|
SUCCESSFUL LONG-TERM OUTCOME USING EXISTING NATIVE CUTANEOUS URETEROSTOMY FOR RENAL TRANSPLANT DRAINAGE. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67897-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
SUCCESSFUL LONG-TERM OUTCOME USING EXISTING NATIVE CUTANEOUS URETEROSTOMY FOR RENAL TRANSPLANT DRAINAGE. J Urol 2000. [DOI: 10.1097/00005392-200002000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
21
|
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]
|
22
|
|
23
|
|
24
|
|
25
|
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.
Collapse
Affiliation(s)
- A M Lucon
- Division of Urology, São Paulo University Medical School, Brazil
| | | | | | | | | | | |
Collapse
|
26
|
Churchill BM, Steckler RE, McKenna PH, Khoury AE, McLorie GA, Shoskes D. Renal transplantation and the abnormal urinary tract. Transplant Rev (Orlando) 1993. [DOI: 10.1016/s0955-470x(05)80008-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Gill IS, Hayes JM, Hodge EE, Novick AC. Clean intermittent catheterization and urinary diversion in the management of renal transplant recipients with lower urinary tract dysfunction. J Urol 1992; 148:1397-400. [PMID: 1433536 DOI: 10.1016/s0022-5347(17)36920-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Renal transplant recipients with lower urinary tract dysfunction may be managed by urinary diversion or clean intermittent catheterization. To evaluate the comparative problems associated with each mode of therapy we studied 13 patients managed by clean intermittent catheterization (group 1, 6 patients) or urinary diversion (group 2, 7 patients). All 6 and 2 of 7 recipients in groups 1 and 2, respectively, had a neuropathic bladder. Mean followup was 3.7 +/- 1.5 (group 1) and 5.7 +/- 4.9 (group 2) years. Three allografts were lost in group 2 due to rejection (2) and death (1). Two patients each in groups 1 and 2 had febrile urinary tract infections requiring hospitalization and intravenous antibiotics. Complications related to urinary diversion developed in 4 patients in group 2. The serum creatinine at 1 and 3 years, number of hospital days per patient, total number of rejection episodes and number of patients employed in a full-time job following transplantation were similar in both groups. In summary, clean intermittent catheterization appears to have more morbidity in immunosuppressed transplant versus nontransplant patients but it may be preferable in renal transplant recipients due to the overall simplicity, positive psychological effect and comparable morbidity to other forms of management.
Collapse
Affiliation(s)
- I S Gill
- Department of Urology, Cleveland Clinic Foundation, Ohio
| | | | | | | |
Collapse
|
28
|
Tsai SY, Wong CC, Smith EK, Diciommo P, Ludwin D. Terminal loop cutaneous ureterostomy in renal transplantation. Urology 1992; 40:280-2. [PMID: 1523757 DOI: 10.1016/0090-4295(92)90493-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients presenting for renal transplantation with urinary diversion abnormalities pose serious problems. The use of a terminal loop cutaneous ureterostomy (TLCU) in patients whose outcome was satisfactory was first described in 1977. Primary urinary drainage was achieved in 3 recipients of cadaver renal allografts by creating a TLCU. This method of drainage has been satisfactory in these patients with follow-up between four and thirty months. We suggest that this simple technique should be considered more frequently for selected patients who require supravesical urinary diversion.
Collapse
Affiliation(s)
- S Y Tsai
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | |
Collapse
|
29
|
Nguyen DH, Reinberg Y, Gonzalez R, Fryd D, Najarian JS. Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study. J Urol 1990; 144:1349-51. [PMID: 2231923 DOI: 10.1016/s0022-5347(17)39737-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A total of 17 patients with intestinal urinary diversion of enterocystoplasty underwent renal transplantation between 1970 and 1988. Patient age ranged from 4 to 35 years (mean age 20 years). The patients were divided into 2 groups. In group 1 (10 patients, 2 of whom required retransplantation) the ureter of the transplanted kidney was implanted into an ileal (7) or colonic (1) conduit or enterocystoplasty (2). In group 2 (7 patients, 1 of whom required a second transplant) the diversion was taken down and the transplanted ureter was implanted into the defunctionalized bladder. There were 14 living related and 6 cadaveric kidneys transplanted. Graft survival rates were 58 and 87% in groups 1 and 2, respectively, with an over-all rate of 70% (14 of 20 kidneys). There was no statistical difference in the graft survival rate between the 2 groups. The complications in group 1 included ureteroileal anastomotic leak (3 patients), ureteroileal stenosis (1), calculus formation (1), urosepsis (1), hyperchloremic metabolic acidosis (1), and wound infection and dehiscence (1). There were no complications in group 2. Renal transplantation into a pre-existing urinary intestinal conduit or augmented bladder does not statistically adversely affect patient or graft survival. However, the complication rate is much higher when the ureter is implanted into an intestinal segment. Therefore, it is preferable whenever possible to implant the ureter into the native bladder.
Collapse
Affiliation(s)
- D H Nguyen
- Department of Urologic Surgery, University of Minnesota Hospital, Minneapolis
| | | | | | | | | |
Collapse
|
30
|
Heritier P, Perraud Y, Relave MH, Barral X, Guerin C, Genin C, Gilloz A, Berthoux F. Renal transplantation and Kock pouch: a case report. J Urol 1989; 141:595-6. [PMID: 2645422 DOI: 10.1016/s0022-5347(17)40905-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report on a young woman with anuric, terminal renal insufficiency whose bladder could not be used for renal transplantation. A Kock pouch was implanted during stage 1 of treatment and the capacity of the pouch was increased artificially with physiological saline solution. The patient subsequently underwent renal transplantation. Results were excellent with regard to continence and ease of catheterization. No complications due to infection were observed despite immunosuppression and electrolyte disorders were minor.
Collapse
Affiliation(s)
- P Heritier
- Département d'Urologie, Hôpital Nord, Centre Hospitalier, Universitaire de St. Etienne, Saint Priest, France
| | | | | | | | | | | | | | | |
Collapse
|