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Evaluation of Biomaterials for Bladder Augmentation using Cystometric Analyses in Various Rodent Models
Published on: August 9, 2012
Effects of urinary tract infection in patients with bladder augmentation and kidney transplantation
Daniel Alcântara Pereira1, Ubirajara Barroso, Paula Machado
1Federal University of Sao Paulo, Sao Paulo, Brazil.
Insights
Children with augmented bladders undergoing kidney transplants had more urinary tract infections but similar graft survival rates compared to controls. This highlights the importance of monitoring for infections in these patients.
Area of Science:
- Urology
- Nephrology
- Transplantation Medicine
Background:
- Bladder augmentation is a surgical procedure to increase bladder capacity.
- Renal transplantation is a common treatment for end-stage renal disease.
Purpose of the Study:
- To evaluate renal allograft function decline in pediatric patients with augmented bladders post-transplantation.
- To assess the prevalence of asymptomatic bacteriuria and urinary tract infections (UTIs) in these patients.
- To determine if bacteriuria or UTIs predict allograft function decline.
Main Methods:
- Retrospective comparison of 23 children with augmented bladders to 42 matched controls who underwent renal transplantation.
- Matching criteria included gender, age, race, donor type, weight, and immunosuppression protocol.
- Analysis of follow-up data, acute rejection rates, UTIs, asymptomatic bacteriuria, hospital admissions, and graft function.
Main Results:
- The augmented bladder group had a significantly higher incidence of UTIs or asymptomatic bacteriuria (83% vs. 17%, p <0.001).
- Patients with augmented bladders experienced more hospital admissions (61% vs. 29%, p = 0.004).
- No statistically significant difference in renal allograft function was observed between groups at 6 or 12 months post-transplantation.
Conclusions:
- Pediatric patients with augmented bladders undergoing renal transplantation exhibit increased rates of asymptomatic bacteriuria and UTIs.
- Despite higher infection rates, augmented bladders did not negatively impact renal allograft survival in this cohort.
- Further research may explore strategies to mitigate infection risk in augmented bladders post-renal transplantation.
Purpose:
We evaluated the rate of function decline of the renal allograft in patients with augmented bladder. We also evaluated the prevalence of asymptomatic bacteriuria and urinary tract infection in these patients, and to demonstrate if these findings are predictors of allograft function decline, comparing children who underwent bladder augmentation with a control group.
Materials And Methods:
Among 170 children and adolescents undergoing renal transplantation at our institution 23 (14%) had previously undergone bladder augmentation. These patients were retrospectively compared (1:2 ratio) to 42 controls matched for gender, age, race, donor type, weight and immunosuppression protocol. The type of donor (living or cadaver), rate of acute tubular necrosis and cold ischemia time during transplantation were also similar between groups.
Results:
Mean followup was 18.0 +/- 13.9 months and 25.2 +/- 14.1 months for the augmented and nonaugmented bladder groups, respectively (p >0.05). The incidence of acute rejection within the first 12 months of kidney transplantation was 9% in the bladder augmentation group and 26% in controls (p >0.05). The rate of urinary tract infection or asymptomatic bacteriuria in the first 12 months after kidney transplantation was higher in the bladder augmentation group (19 patients, 83%) compared to controls (7 patients, 17%, p <0.001). Patients with augmented bladder had a higher number of hospital admissions (14 patients, 61%) compared to the control group (12 patients, 29%, p = 0.004). Despite the higher incidence of urinary tract infection in the augmented bladder group, there was no statistically significant difference in graft function between the groups at 6 months (1.1 +/- 0.3 mg/dl vs 1.0 +/- 0.3 mg/dl) or 12 months (1.0 +/- 0.2 mg/dl vs 1.2 +/- 0.7 mg/dl) after transplantation.
Conclusions:
Our study demonstrated that patients with transplanted kidney and augmented bladder had more asymptomatic bacteriuria and urinary tract infections than those without bladder augmentation. However, the rate of graft survival was similar between the groups.
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