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Renal transplantation in augmented bladders.

P López Pereira1, M J Martínez Urrutia, R Lobato

  • 1Department of Paediatric Urology, University Hospital "La Paz", Pº de la Castellana 261, Madrid, 28046, Spain, plpuro@hotmail.com.

Current Urology Reports
|June 12, 2014
PubMed
Summary

Pediatric renal transplantation is now successful in children with bladder dysfunction using augmentation cystoplasty (AC). This procedure creates a functional bladder reservoir, improving graft survival rates despite potential urinary tract infection risks.

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Area of Science:

  • Pediatric Urology
  • Transplantation Surgery
  • Nephrology

Background:

  • Children with lower urinary tract abnormalities or bladder dysfunction were historically high-risk for renal transplantation.
  • Poorly compliant, low-capacity bladders posed significant challenges to successful kidney graft outcomes.

Purpose of the Study:

  • To evaluate the efficacy and safety of augmentation cystoplasty (AC) in pediatric renal transplant recipients with bladder dysfunction.
  • To assess the impact of AC on graft survival, function, and complication rates.

Main Methods:

  • Review of outcomes in pediatric patients who underwent renal transplantation with concurrent augmentation cystoplasty.
  • Comparison of graft survival, function, and complication rates (e.g., UTIs) between patients with and without AC.

Main Results:

  • Augmentation cystoplasty creates a compliant, low-pressure reservoir, preserving kidney grafts in children with bladder dysfunction.
  • Urinary tract infections (UTIs) in AC patients are often linked to catheterization noncompliance or vesicoureteral reflux, not the AC itself, and typically do not impair graft function.
  • Pediatric renal transplant recipients with AC achieve similar graft survival and function outcomes as those with normal bladders.

Conclusions:

  • Augmentation cystoplasty is a viable and effective procedure for pediatric renal transplant recipients with bladder abnormalities.
  • While UTIs can occur, they are manageable and do not negate the benefits of AC for graft preservation.
  • Long-term monitoring for potential malignant transformation in the augmented intestinal segment is warranted.