Renal Transplantation in Patients With “Valve Bladder”: Is Bladder Augmentation Necessary?

• Published in: Transplantation proceedings 2010-05, Vol.42 (4), p.1069-1073
• Main Authors: Capozza, N, Torino, G, Collura, G, Battaglia, S, Guzzo, I, Caione, P, Strologo, L. Dello
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anuria - surgery; Biological and medical sciences; Child; Child, Preschool; Creatinine - blood; Diuresis - physiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Kidney Function Tests; Kidney Transplantation - physiology; Medical sciences; Oliguria - surgery; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Outcome; Ureter - surgery; Ureter - transplantation; Urinary Bladder - anatomy & histology; Urinary Bladder - surgery; Urinary Bladder Diseases - surgery; Urinary Tract - abnormalities
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.03.040

Abstract Introduction Posterior urethral valve is a common cause of renal failure in children. This disorder often results in small bladder and low compliance, which frequently requires bladder augmentation. Herein, we report our experience in 5 children with “valve bladder” who underwent renal transplantation without preliminary bladder enlargement. Materials and Methods Thirteen children with valve bladder undergoing renal transplantation were considered candidates for bladder augmentation. All had oligoanuria at transplantation. In 8 children, bladder augmentation was performed before renal transplantation; in the remaining 5, the decision was postponed until after transplantation. These children underwent transplantation with a ureteral reimplant, and a suprapubic catheter was in place for 2 months. Periodically, renal function, bladder capacity, and compliance were assessed, and renal ultrasonography was performed. Results At 1-, 2-, 4-, and 6-month follow-up, the 5 children who did not undergo bladder augmentation demonstrated normal renal function, with improved bladder capacity and absence of hydronephrosis. No significant difference was evident between the 2 groups (augmented vs nonaugmented) insofar as renal function, bladder capacity, or hydronephrosis. After transplantation, bladder augmentation was not deemed necessary in any of the 5 children because of complete restoration of clinical and urodynamic parameters. Conclusion Renal transplantation can be performed safely without preemptive bladder augmentation. Ureteral reimplantation is recommended, even in patients with small valve bladders. The decision about the need for bladder augmentation should be made only after normal diuresis is restored.