[Urological treatments before and after kidney transplantations]

The repair of pre-existing bladder sphincter lesions in patients excluded from kidney transplant programs, and the recovery of grafts threatened by ureteral complications, are favourable influences in establishing equilibrium between dialysis and transplantation. In a series of 74 kidney transplants, two patients were able to receive grafts: one after the reconstruction of an ileal tube and the other after bladder diverticulectomy and resection of the bladder neck. Two other grafts, complicated by ureteral necrosis, were able to be conserved following a uretero-ureterostomy in the first case, and a psoic bladder in the second. These repair operations are discussed from three points of view: incidence, procedures, and complications. Advances made in transplanting kidneys encourage its use in patients who were previously excluded from receiving transplants because of bladder sphincter lesions. These lesions can be the cause of a renal insufficiency, or those associated with the original kidney disease. This group of patients represents 3 to 5% of the population of patients on permanent dialysis who respond to the other criteria for inclusion in the lists of potential receivers of kidney transplants: some of them could benefit from the graft if their lesions were treated by the standard urological methods. Furthermore, 5 to 8% of those with kidney transplants could lose the grafted kidney, which is immunologically tolerated, because of urological complications. As with patients in the first category, they also could obtain benefit from repair procedures on the urinary tract. A total of 74 kidney grafts were performed in the Sheba medical Center between March 1971 and July 1977: two patients were able to benefit from preventive urological procedures before transplantation: two others with grafts developed ureteral complications and were benefited by therapeutic procedures rarely used in kidney transplantation cases.