Augmentation of the bladder in preparation for renal transplantation

Although loop urinary diversion has been used successfully with renal allograft recipients, the potential and real morbidity of these diversions has led us to avoid this type of reconstruction in favor of the reconstructed bladder (3). Many of our first patients had undergone reconstruction or undiversion prior to the establishment of renal insufficiency and had a variety of augmentations (two ileocecal and three sigmoid). One additional patient underwent ileal patch augmentation three years after transplantation. However, many patients are now being seen in preparation for renal transplantation who have urinary diversions or require reconstruction and have such poor renal reserve that renal replacement therapy is inevitable. It is this latter group of patients who have prompted us to define what is the most suitable form of reconstruction of the bladder when subsequent transplantation is planned. Many forms of reconstruction and undiversion are available and appear to be equally satisfactory in the management of patients with lower urinary tract dysfunction. However, patients who are to undergo renal transplantation subsequently should be given consideration regarding the technical feasibility of the transplant operation. Accordingly, we believe that simple augmentation of the sigmoid colon as described herein prevents dissection of either iliac fossa, which greatly facilitates implantation of the allograft. As there currently appears to be no superior segment of both the large and small intestine or configuration for augmentation, augmentation of the sigmoid colon is at least as effective as other modes of reconstruction and, therefore, should be strongly considered in this population of patients.(ABSTRACT TRUNCATED AT 250 WORDS)