Comparison of Renal Transplantation Outcomes in Children With and Without Bladder Dysfunction. A Customized Approach Equals the Difference

Abstract

With individualized treatment children with severely inferior lower urinary tract function may undergo renal transplantation with a safe and adequate outcome.

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

“…One patient with neurogenic bladder and all patients with PUV were maintained on behavioural interventions and anticholinergics. Similarly to reports by many other authors, we prefer reconstructive surgeries before RTx to avoid the possible adverse effects of immunosuppression, such as delayed wound healing and severe infection, in addition to the prevention of any harmful effect of LUTD on the graft [16,19]. It may not always be necessary to intervene in patients with borderline bladder compliance, however, as a small non-compliant bladder may improve after transplantation in some cases after restoration of urinary flow, sparing the patients a reconstructive surgery [10,21,22].…”

“…Although some authors confirmed that outcomes for RTx in children with LUTD were similar to those in children with normal lower urinary tracts [9][10][11][12][13][14], LUTD may have a significant impact on graft survival if not managed appropriately [4,15]. Low intravesical pressure with adequate bladder capacity and compliance, together with efficient drainage, should be achieved for a successful transplantation [11,12,[16][17][18]. In patients with LUTD, the urinary tract should be thoroughly evaluated before transplantation by VCUG and urodynamic studies to assess the capacity, compliance, postvoid residual urine, the presence of reflux, and any bladder dysfunction in addition to the urethral condition [13,14,16,19].…”

“…Low intravesical pressure with adequate bladder capacity and compliance, together with efficient drainage, should be achieved for a successful transplantation [11,12,[16][17][18]. In patients with LUTD, the urinary tract should be thoroughly evaluated before transplantation by VCUG and urodynamic studies to assess the capacity, compliance, postvoid residual urine, the presence of reflux, and any bladder dysfunction in addition to the urethral condition [13,14,16,19].…”

“…The median (range) follow-up after transplantation was 36 (6-62 months). Nahas et al [16] compared the outcomes of RTx among 136 children with a non-urological cause (group 1), 56 children with a urological disorder but with an adequate bladder (group 2a) and 19 children with LUTD with either inadequate compliance or difficulties with bladder drainage (group 2b). All children in group 2b underwent bladder augmentation or urinary diversion.…”

Pediatric Kidney Transplant in Uropaties

“…In many health care centers, ileal segments are chosen to perform colocystoplasty (Nahas et al, 2007), whereas at Hospital de Pediatría Prof. Dr. J. P. Garrahan and since several years ago, sigmoid colon segments without specific bowel preparation have been the segments of choice. No significant infection complications have been observed postoperatively.…”