[Bladder augmentation and urinary diversion in kidney transplant candidates]

Area of Science:

• Urology
• Transplantation Surgery
• Reconstructive Surgery

Context:

• Kidney transplantation (KT) is the preferred treatment for end-stage renal disease (ESRD).
• Lower urinary tract anomalies affect 6% of ESRD patients, often necessitating reconstructive surgery before KT.
• Pathologic bladders can impede successful kidney transplantation.

Purpose:

• To evaluate the safety and efficacy of using bowel segments for lower urinary tract reconstruction in patients undergoing kidney transplantation.
• To assess outcomes in patients with complex uropathies requiring bladder augmentation or diversion prior to KT.

Summary:

• Reviewed 6 kidney transplant recipients (3 pediatric) who underwent lower urinary tract reconstruction with bowel segments (colon or ileum) between 8 and 147 months pre-transplant.
• Common indications included neurogenic bladder, contracted bladder post-tuberculosis, urethral valves, and post-cystoprostatectomy.
• Techniques involved bladder augmentation with colon, Bricker's ileal loop, or Goodwin's ileal bladder augmentation.

Impact:

• Despite complications like UTI and stenosis, all patients achieved good outcomes with no graft loss.
• Post-transplant serum creatinine levels ranged from 0.69 to 2.6, indicating preserved graft function.
• Bowel reconstruction is a safe and effective method enabling kidney transplantation in patients with non-rehabilitative bladders.