Long-Term Outcome of Simultaneous or Staged Urinary Diversion and Kidney Transplantation

Abstract

Objectives: We retrospectively analyzed the long-term outcomes of simultaneous or staged urinary diversion and kidney transplantation. Patients and Methods: Between June 2001 and December 2012, 4 patients with dysfunctional bladder resulting from spina bifida (n = 3) or bladder contraction following urologic tuberculosis (n = 1) underwent cadaveric kidney transplantation and urinary diversion simultaneously (n = 3) or 6 months post-transplantation (n = 1). Urinary diversion consisted of cutaneous ureterostomy in 1 patient and ileal conduits in 3 patients. All patients were followed prospectively. Results: All 4 patients received deceased donor transplants. Median follow-up was 110.5 months (range 50-120). At the last follow-up, serum creatinine levels ranged from 1.1 to 1.8 mg/dl. One patient with a functioning graft died of severe cirrhosis 105 months following transplantation. Graft function remained stable without any severe complications in 3 patients. Hematoma (Clavien-Dindo grade IIIa) and urinary leakage (grade II) occurred in 1 patient in the early postoperative period, but no surgical revision was required. Two patients developed cytomegalovirus pneumonia. Urinary tract infection was a common problem in all patients. Conclusions: For patients with lower urinary tract dysfunction, simultaneous kidney transplantation and urinary diversion with an ileal conduit may be a safe, feasible approach, with a satisfactory long-term outcome.

Intraperitoneal laparoscopic Mitrofanoff procedure: Ureterocutaneostomy concomitant nephrectomy in a child with kidney transplantation: First case report

“…The type of urinary diversion should be considered carefully, according to the condition of each individual [1,2,6,7]. Infectious disorder is an important risk factor that can result in failure of urinary diversion and kidney transplantation or reject [2,6,8,9].…”

“…Infectious disorder is an important risk factor that can result in failure of urinary diversion and kidney transplantation or reject [2,6,8,9]. Many authors mentioned, when transplant is performed, reconstruction renal function is optimized before undergoing the major procedure and its associated morbidity, the conduit for urinary tract reconstruction and /or augmentation before transplant may be unnecessary [2,3,8,10].…”

“…The ureter of transplanted kidney needs to be anastomosed to a urine reservoir, with adequate compliance, capacity and efficient voluntary emptying [2,9]. In this child, we had observed a storage of urine bladder that manifested by recurrence infection of the urinary tract due to a High compliance bladder and a raised intravesical pressure that were considered the indications to create a continent conduit between bladder and skin [6,8,9,11]. The duration of operation was 146 minutes compared others studies that mentioned 111 minutes (range 85 to 175) for laparoscopic ureterocutaneostomy [5,12].…”

“…A randomized, controlled trial has shown that it is also not necessary for children on CIC to be on prophylactic antibiotics, however, in patient with kidney transplant we recommended the prophylactic because immunosuppressive medication may influence in the outcome [6,7,9,17]. The incidence of stomal stenosis with appendix was 24%, there were more complications in umbilical stomal, but the reason is unclear [1,2,4,18].…”

Current possibilities of improving the results of kidney transplantation in patients of the older age group, including those with an aggravated urological history

“…У больных со сморщенным или нейрогенным мочевым пузырем перед трансплантацией возможно внепузырное отведение мочи или расширяющая энтероцистопластика [66,67]. По мнению L. Teng et al [68], у больных со сморщенным или нейрогенным мочевым пузырем возможно проводить расширяющую пластику мочевого пузыря с использованием сегмента тонкой кишки одновременно с пересадкой почки, поскольку это не приводит к росту осложнений и обеспечивает хорошие отдаленные результаты трансплантации (при сроках наблюдения 50-120 мес уровень креатинина крови составлял 1,1-1,8 мг/дл).…”