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Enterocystoplasty in renal transplantation candidates: urodynamic evaluation and outcome
M R Zaragoza1, M L Ritchey, D A Bloom
1Department of Surgery, University of Michigan, Ann Arbor.
Insights
Enterocystoplasty safely improves bladder function in end-stage renal disease patients awaiting kidney transplants. This bladder augmentation surgery enhances capacity and compliance, leading to successful renal graft survival.
Area of Science:
- Urology
- Nephrology
- Transplantation Surgery
Background:
- End-stage renal disease (ESRD) often presents with bladder dysfunction, including small, poorly compliant bladders.
- This condition complicates renal transplantation and impacts post-transplant outcomes.
- Enterocystoplasty is a surgical option for bladder augmentation.
Purpose of the Study:
- To evaluate the safety and efficacy of enterocystoplasty in ESRD patients awaiting renal transplantation.
- To assess the impact of bladder augmentation on lower urinary tract function and renal graft survival.
Main Methods:
- Eleven ESRD patients with small, noncompliant bladders underwent enterocystoplasty prior to renal transplantation.
- Detubularized bowel segments (ileum, ileocecal, sigmoid) were used for augmentation.
- Urodynamic studies were performed before and after surgery.
Main Results:
- Enterocystoplasty significantly improved bladder capacity and compliance.
- Patients received 13 renal transplants with an 85% graft survival rate at a mean follow-up of 30.1 months.
- No perioperative complications or bladder ruptures occurred; all patients remained continent with clean intermittent catheterization.
Conclusions:
- Enterocystoplasty is a safe and effective procedure for restoring lower urinary tract function in ESRD patients with small, noncompliant bladders.
- Bladder augmentation facilitates successful renal transplantation and improves patient quality of life.
- This technique offers a viable solution for managing complex bladder dysfunction in the context of ESRD and transplantation.
Abstract:
In anticipation of renal transplantation 11 patients with end stage renal disease and small volume, poorly compliant bladders underwent enterocystoplasty. The etiology of bladder dysfunction included myelodysplasia in 4 patients, posterior urethral valves in 4 and vesicoureteral reflux in 3. Mean patient age at the time of bladder augmentation was 16.4 years (range 10 to 28). Detubularized bowel segments were used in all patients and included ileum in 7, ileocecal segment in 3 and sigmoid in 1. Urodynamic evaluation before and after enterocystoplasty demonstrated marked improvement in bladder capacity and compliance. These 11 patients have received 13 renal transplants with an 85% graft survival at a mean followup of 30.1 months. No bladder ruptures or other perioperative complications have occurred. All patients remain continent on clean intermittent catheterization. Our experience suggests that enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small, noncompliant bladder.