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Renal transplantation in children following augmentation ureterocystoplasty
E H Landau1, V R Jayanthi, G A McLorie
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Augmentation ureterocystoplasty using megaureters improves bladder function, leading to successful renal transplantation in children with bladder dysfunction. This approach avoids complications associated with other augmentation methods.
Area of Science:
- Pediatric Urology
- Transplant Surgery
- Reconstructive Urology
Background:
- Children with end-stage renal failure often have dysfunctional bladders.
- Dysfunctional bladders can complicate successful renal transplantation.
- Augmentation cystoplasty aims to improve bladder capacity and compliance.
Observation:
- Two pediatric patients with end-stage renal failure due to myelodysplasia and posterior urethral valves underwent augmentation ureterocystoplasty.
- Megaureters were utilized for bladder augmentation to avoid enteric or gastric augmentation complications.
- Both patients subsequently underwent successful cadaveric renal transplantation.
Findings:
- Augmentation ureterocystoplasty significantly improved bladder storage function in both patients.
- The use of megaureters obviated the sequelae associated with enteric or gastric augmentation.
- Both renal transplants were successful, with patients maintaining normal renal function at 4 and 3 years post-transplantation.
Implications:
- Renal transplantation into megaureter-augmented bladders is a successful strategy.
- Urothelial-lined augmentation (megaureter) avoids potential complications of enterocystoplasty or cystoplasty.
- This technique offers a safer alternative for pediatric patients requiring renal transplantation and bladder augmentation.
Objectives:
To assess the impact of augmentation ureterocystoplasty on the success of cadaveric renal transplantation in children with dysfunctional bladders.
Methods:
Two patients with end-stage renal failure secondary to dysfunctional bladders (one myelodysplasia and one posterior urethral valves) underwent augmentation ureterocystoplasty prior to renal transplantation in order to increase bladder capacity and improve compliance.
Results:
Significant improvement of bladder storage function was achieved in both patients. By the use of megaureter for augmentation, untoward sequelae of enteric or gastric augmentation were obviated. Renal transplantation was successful in both patients. Both have normal renal function 4 and 3 years after transplantation.
Conclusions:
Renal transplantation into bladders previously augmented with megaureters is successful. The use of urothelial-lined biomaterial for augmentation avoids the potential complications of gastro- or enterocystoplasty, which are especially dangerous in transplant patients.