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Sacral neuromodulation enabling simultaneous pancreas and kidney transplantation: a first case
Donatella Pistolesi1, Massimiliano Barsotti, Gianluca Giannarini
1University of Pisa, Urology, Pisa, 56126, Italy.
BMJ Case Reports
|June 21, 2011
Summary
Sacral neuromodulation resolved chronic urinary retention and recurrent infections in a diabetic patient, enabling successful simultaneous pancreas and kidney transplantation for end-stage renal disease.
Area of Science:
- Nephrology
- Urology
- Transplantation Surgery
Background:
- Recurrent urinary tract infections (UTIs) secondary to chronic urinary retention (CUR) can preclude kidney and pancreas transplantation.
- Diabetic patients with end-stage renal disease (ESRD) often present complex medical histories impacting transplant eligibility.
Purpose of the Study:
- To investigate the efficacy of sacral neuromodulation (SNM) in managing CUR and recurrent UTIs in a patient with ESRD.
- To determine if SNM could enable a diabetic patient to proceed with simultaneous pancreas and kidney transplantation (SPKT).
Main Methods:
- A case study detailing a diabetic woman with ESRD and CUR requiring clean intermittent self-catheterization (CISC).
- Implementation of sacral neuromodulation to address the underlying voiding dysfunction.
- Monitoring of UTI recurrence and voiding function post-SNM.
Main Results:
- Sacral neuromodulation successfully restored normal voiding function.
- Recurrent urinary tract infections were eradicated following SNM.
- The patient became eligible for and proceeded with simultaneous pancreas and kidney transplantation.
Conclusions:
- Sacral neuromodulation is a viable therapeutic option for chronic urinary retention and recurrent UTIs in ESRD patients.
- Successful management of voiding dysfunction with SNM can facilitate eligibility for complex organ transplantation procedures like SPKT.
- This case highlights the importance of addressing non-transplant-limiting conditions to optimize patient selection for transplantation.
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