Renal Transplantation in Patients with Posterior Urethral Valves

Abstract

Renal transplantation into a valve bladder is not associated with an abnormally high rate of failure. Deterioration of graft function secondary to lower urinary tract dysfunction is uncommon, with the majority of patients able to use the unmodified native bladder as a receptacle for the transplanted kidney.

Comparative outcome analysis of pediatric kidney transplant in posterior urethral valves children with or without pretransplant Mitrofanoff procedure

“…It was hypothesized that this was primarily due to bladder dysfunction. More recent papers have reported that overall success rates for PUV patients are similar to control patients with medical causes for transplant with acknowledgment of the need for aggressive control of bladder function before transplant 2,9,10,17 . Kamal et al reviewed 20 PUV patients from their institution and reported similar graft outcomes when compared to controls.…”

“…When we categorized our patients into those with and without Mitrofanoff (Table 1) Table S1. 2,9,10,17 Kamal et al reviewed 20 PUV patients from their institution and reported similar graft outcomes when compared to controls. They noted that PUV patients were significantly younger at the time of RT; however, their age at presentation for PUV was 5 years suggesting that many of these boys may have already progressed to ESRD by the time of diagnosis.…”

“…1 Despite early intervention and close, multidisciplinary follow-up of PUV patients, 30%-50% will progress to end-stage renal disease (ESRD) and ultimately require renal transplant (RT). [2][3][4] Although irreversible renal dysplasia occurring in utero is thought to be the primary cause of chronic kidney disease (CKD), 5 bladder dysfunction (valve bladder syndrome) is known greatly contribute to renal function deterioration. 6,7 Small, low compliance bladders cause high intravesical pressure-particularly during the storage phase which makes it difficult for the ureter to empty into the bladder adequately.…”

“…With advances in prenatal screening, most cases of posterior urethral valves (PUV) are now diagnosed prenatally and interventions to address the obstruction are carried out shortly after birth 1 . Despite early intervention and close, multidisciplinary follow‐up of PUV patients, 30%‐50% will progress to end‐stage renal disease (ESRD) and ultimately require renal transplant (RT) 2‐4 …”

The long‐term complications of posterior urethral valves

“…It is well recognized that libido and potency is markedly aCected in survival may be reduced significantly by transplantation into a valve bladder. Eleven large series [37][38][39][40][41][42][43][44][45][46][47], with a adults with chronic renal failure [50]. Thus, it is not unexpected to find problems with sexual function in men total of 184 patients, have examined this issue ( Table 1).…”