Orthotopic Neobladder in a Woman After Kidney Transplantation

Colombo, T.; Zigeuner, Richard; Zitta, Sabine; Petritsch, P.; Hubmer, G

doi:10.1016/s0022-5347(01)68212-0

Cited by 20 publications

(15 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date there are only four reported cases of renal transplantation into an orthotopic bladder [39]. These were in children with severe congenital urinary tract anomalies before renal transplantation and in men and women previously treated by cystectomy for invasive TCC.…”

Section: Transplantation Into Orthotopic Neobladdersmentioning

confidence: 99%

Renal transplantation into the abnormal lower urinary tract

2003

View full text Add to dashboard Cite

Section: Transplantation Into Orthotopic Neobladdersmentioning

confidence: 99%

Renal transplantation into the abnormal lower urinary tract

2003

View full text Add to dashboard Cite

“…Therefore, the fashioning of an orthotopic ileal neobladder in a renal transplant patient can be recommended when cystectomy is required, since, according to our experience and that of others [4, 5,7,8,91, it proved to be feasible, safe (thanks to the improved quality of suture materials) and adequate to preserve graft function. There are several ways of making a detubularized ileal neobladder, but Studer technique, which assures an intact afferent ileal loop, is particularly suitable for tract reconstruction following renal transplantation, since this loop can be anastomosed to the short graft ureter, and its preserved peristalsis prevents reflux and hydronephrosis.…”

Section: Discussionmentioning

confidence: 93%

“…For superficial bladder tumors, intravesical chemotherapy should be used with caution and only using Mitomycin C [5]. Bacillus Calmette GuZrin (BCG), which currently represents the gold standard for multicentric, recurrent or grade 3 superficial tumors, should not be administered to immunosuppressed patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function

Selli¹,

Boggi²,

Travaglini³

et al. 2004

Transplant Int

View full text Add to dashboard Cite

In case of cystectomy, some forms of urinary diversion can impair the graft function of renal transplant patients. Here we present the case of a 70-year-old male with carcinoma of the bladder 12 years after renal transplantation. Immunosuppression was achieved with Cyclosporin A (200 mg/day) and Prednisone (5 mg/day). The patient's serum creatinine level was 1.4 mg/dl. Following cystectomy, an orthotopic ileal neobladder was constructed by means of Studer technique, and the afferent ileal loop was anastomosed to the graft ureter.Pathology revealed pT1 G3 N + transitional cell carcinoma. Ten months later, periaortic nodal recurrences necessitated four cycles of chemotherapy with Epidoxorubicyn and Gemcytabine. To date, 20 months after cystectomy, the patient is stable, with day and nighttime urinary continence. His serum creatinine level is 1.3 mg/dl, and there is no evidence of hydronephrosis or acidosis. We conclude that the orthotopic ileal neobladder is an effective form of urinary diversion in renal transplant patients requiring cystectomy, allowing good preservation of the renal function. Keywords Kidney transplantationBladder neoplasms . Urinary diversion Abbreviations BCG Bacillus Calmette GulrinImmunosuppression following renal transplantation increases the risk of tumor development, including that of bladder carcinoma [l]. Radical cystectomy may be necessary in these patients, however, some forms of urinary diversion, such as an ileal conduit, may impair graft function. Here we report the case of an orthotopic ileal neobladder allowing good preservation of renal function in a renal transplant patient. Case reportThe patient, a 70-year-old male, had undergone cadaveric kidney transplantation 12 years previously. The graft, with a cold ischemia time of 14 h, was from a 15-year-old female donor of identical haplotype.The initial immunosuppressive regimen was Cylosporine A (CSA) 230 mg/day, Azathioprine 50 mg/day and Prednisone 15 mg/day. Due to patient age, the immunosupperessive regimen was tapered over the years to CSA 200 mg/day and Prednisone 5 mg/day. The graft was functioning well with a serum creatinine level of 1.4 mg/dl. During the previous year, two transurethral superficial bladder tumors had been resected, and a recent third resection revealed pT1 G3 transitional cell carcinoma. Spiral CT scan failed to demonstrate enlarged pelvic lymph nodes and showed two shrunken native kidneys, the chest X-ray was normal.The patient underwent radical cystectomy with right-sided pelvic lymphadenectomy, since the graft was placed in the left iliac fossa. An ileal orthotopic neobladder was fashioned by means of Studer technique using 55 cm of the terminal ileum, which was detubularized and folded twice, leaving a 14 cm afferent ileal loop, which was anastomosed to the graft ureter in the left iliac fossa by means of the "split cuff' technique (Fig. 1). The postoperative

show abstract

“…Various methods of urinary diversion in patients with prior renal transplantation have been reported in the literature. 6–8 More recent literature on urinary diversion in the renal transplant population have focused on orthotopic diversion as the method of choice due to improved aesthetics, ability to preserve renal function, and ability to provide normal voiding function. 2,9–14 …”

Section: Introductionmentioning

confidence: 99%

Radical Cystectomy and Orthotopic Urinary Reconstruction in Patients With Bladder Cancer After Renal Transplantation: Clinical Outcomes and Description of Technique

Moses

Bochner

Prabharasuth

et al. 2013

Transplantation Proceedings

View full text Add to dashboard Cite

Objectives Radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. In the setting of prior renal transplantation, surgical treatment remains the mainstay but is technically challenging. We report our patient outcomes in this unique population with a description of the technique. Methods We identified five patients with a prior history of renal transplantation who underwent RC and orthotopic urinary diversion. Preoperative clinical and demographic features were compiled and disease-specific and functional outcomes were assessed. Intraoperative technical challenges and maneuvers for avoiding complications are highlighted. Results Four patients were male and 1 was female, with a median age of 64 years. Gross hematuria was the most common sign at presentation. Clinical staging was T2, T2 with CIS, HG Ta with CIS, T2 with squamous differentiation, and HG T1, and pathologic tumor stage was pTisN1, pT3N0, pTisN0, pT3N0 and pT0N0, respectively. One patient received a Studer-type diversion and 4 underwent Hautmann diversion. Median followup after cystectomy was 12.9 months. Graft ureteral identification was aided by the use of intravenous dye in all patients. Ipsilateral pelvic lymph node dissection was not possible in any patient. All patients are alive at followup, with two experiencing recurrence at 7.2 months and 66.8 months. No patient experienced a significant decrease in estimated creatinine clearance (eCrCl) post-operatively. Postoperative daytime control was reported by all patients while 2 noted complete nighttime control. Conclusions RC with orthotopic diversion is a technically demanding procedure in patients with a history of prior renal transplantation. Meticulous technique and careful attention to the altered anatomy are required for successful outcomes.

show abstract

Orthotopic Neobladder in a Woman After Kidney Transplantation

Cited by 20 publications

References 2 publications

Renal transplantation into the abnormal lower urinary tract

Renal transplantation into the abnormal lower urinary tract

Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function

Radical Cystectomy and Orthotopic Urinary Reconstruction in Patients With Bladder Cancer After Renal Transplantation: Clinical Outcomes and Description of Technique

Contact Info

Product

Resources

About