Pretransplant defunctionalized bladder—overrated condition?

Neto, João F. Neves; Palomino, Zaira; Watanabe, Ingrid Kazue Mizuno; Aguiar, Wilson; Medina-Pestana, José; Soler, Roberto

doi:10.1002/nau.23495

Cited by 4 publications

(1 citation statement)

References 34 publications

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“…This is no longer widely practiced as studies have consistently shown that kidneys can be safely transplanted into defunctionalized bladders (DB), which regain normal capacity and compliance within 1 year of KT [19][20][21]. Contemporarily, in 2018, Neves Neto et al biopsied bladder mucosa and detrusor samples in 33 patients with defunctionalized bladders and 35 patients with normal bladders (diuresis < 300 vs. > 300 mL/24 h) to compare receptor mRNA levels commonly altered in LUT dysfunction [22]. Apart from a 2.8-fold overexpression of the α 1D adrenergic receptor (p = 0.018) in the defunctionalized bladder cohort, there were no other statistically significant differences in gene expression.…”

Section: Defunctionalized Bladders and Bladder Cyclingmentioning

confidence: 99%

Urodynamics in the Transplant Population

Lee,

Van Kuiken

2024

Curr Bladder Dysfunct Rep

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Purpose of Review Urodynamic testing (UDS) is a valuable tool for understanding the safety of the lower urinary tract (LUT). The goal of this review is to provide evidence-based indications for use of UDS in both the pre-and post-kidney transplant (KT) settings. Recent Findings Pre-transplant bladder cycling with UDS for anuric or oliguric patients is no longer recommended. Instead, UDS aids in identifying LUT anomalies that may require optimization prior to transplant, especially in patients with known urologic etiologies of end-stage renal disease (ERSD). In pre-KT patients with recurrent urinary tract infections (UTIs) or prior urologic/pelvic interventions, UDS should be used judiciously when the etiology of LUT dysfunction is unclear. In the post-transplant setting, urologists are often consulted for LUT symptoms (LUTS), hydronephrosis, urinary retention, declining renal function, and most commonly, recurrent UTI. Again, UDS should not be routinely performed first line, but as an adjunct to distinguish similarly presenting LUT etiologies such as bladder outlet obstruction (BOO) and bladder dysfunction. Summary UDS remains the gold standard for characterizing the LUT, and when utilized appropriately, can identify factors promoting graft and patient survival after KT.

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