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Kidney transplantation in patients with neurovesical dysfunction
T Chikaraishi1, K Nonomura, H Kakizaki
1Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
Summary
Kidney transplantation is feasible in neurovesical dysfunction (NVD) patients if lower urinary tract issues are resolved. Successful management involved addressing anatomical abnormalities and implementing clean intermittent catheterization (CIC) for bladder emptying, leading to good renal function post-transplant.
Area of Science:
- Urology
- Nephrology
- Pediatric Surgery
Background:
- Retrospective review of 5 renal recipients with neurovesical dysfunction (NVD).
- Focus on lower urinary tract anatomical and urodynamic abnormalities.
- Evaluation of pre-transplant management strategies for NVD patients.
Observation:
- Underlying anomalies included posterior urethral valve, meningomyelocele, and congenital short urethra with imperforate anus.
- Urodynamic studies confirmed NVD in all patients, characterized by urinary retention without obstruction.
- All patients presented with bilateral high-grade vesicoureteral reflux requiring intervention.
Findings:
- Successful kidney transplantation achieved after resolving urinary tract problems.
- Clean intermittent catheterization (CIC) was essential for bladder emptying in all cases.
- Augmentation cystoplasty and Mitrofanoff procedures were utilized for bladder management in select patients.
- Post-transplant, 4 out of 5 recipients maintained good renal function, free from urinary tract infections with CIC.
Implications:
- Proper management of lower urinary tract issues is critical for successful kidney transplantation in NVD patients.
- CIC is a key component for achieving a low-pressure urinary storage system and preventing infections.
- Kidney transplantation can restore renal function and improve quality of life for NVD patients with appropriate pre-transplant preparation.