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Related Experiment Videos

Renal transplantation in children with severe bladder dysfunction.

S Mendizábal1, F Estornell, I Zamora

  • 1Service Pediatric Nephrology, Hospital La Fe of Valencia, Avda. Campanar 21, 46009 Valencia, Spain. mendizabal_san@gva.es

The Journal of Urology
|December 14, 2004
PubMed
Summary

Pediatric renal transplantation in children with severe bladder dysfunction can be successful. Careful patient selection and surgical techniques are crucial for optimal graft survival and managing urinary issues.

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Area of Science:

  • Pediatric Nephrology
  • Urology
  • Transplantation Surgery

Background:

  • Children with severe bladder dysfunction face significant risks for renal graft survival.
  • Lower urinary tract abnormalities present unique challenges in pediatric renal transplantation.

Purpose of the Study:

  • To report the outcomes of renal transplantation in 15 children (ages 6-18) with severe lower urinary tract abnormalities.
  • To evaluate the safety and efficacy of pre-transplant urological interventions in this patient cohort.

Main Methods:

  • 18 renal transplants were performed between 1979 and 2003 in children with various congenital bladder dysfunctions.
  • Pre-transplant urological surgeries included bladder augmentations and urinary conduits; voiding was managed via intermittent catheterization or ostomies.

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  • Graft implantation involved an extraperitoneal approach with ureteral anastomosis to the native bladder when augmented.

    • Main Results:

    • Graft survival rates at 1 and 5 years were 77% and 62%, respectively.
    • Urological complications included obstruction, fistula, stones, and infections; three graft losses were attributed to urological disease.
    • The median follow-up was 79 months.

    Conclusions:

    • Renal transplantation in children with severe bladder dysfunction can yield results comparable to the general pediatric population.
    • Meticulous patient selection and surgical techniques that ensure adequate voiding and infection control are essential.
    • Augmentation cystoplasty and intermittent catheterization are effective strategies for managing bladder dysfunction post-transplantation.