title: Augmentation cystoplasty in renal transplantation: a good and safe option--experience with 25 cases.
abstract: OBJECTIVE
  To assess the surgical and long-term results of renal transplantation in 25 patients with bladder dysfunction and augmentation cystoplasty.
  
  
  METHODS
  We retrospectively reviewed the evolution and surgical outcome of 25 renal transplants in 24 recipients with augmentation cystoplasty. The mean patient age at transplantation was 27.6 years. The etiology of bladder dysfunction was neurogenic bladder with detrusor hyperreflexia (11 patients), tuberculosis (5 patients), vesicoureteral reflux (4 patients), posterior urethral valves (3 patients), and interstitial cystitis (1 patient). Seventeen transplants were from living donors. Augmentation cystoplasty was performed before transplantation in 21 patients. The bowel segments used in the augmentation cystoplasty included ileum in 16, ileocecal segments in 2, and sigmoid in 5 patients. The donor ureter was anastomosed to the native bladder in 16 patients, to the bowel segment in 6, and to the native ureter in 3.
  
  
  RESULTS
  Twenty kidneys (80%) were functioning at a mean follow-up of 53.2 months (range 6 to 118). The mean serum creatinine was 1.56 mg/dL (range 0.7 to 2.6). Three patients died of unrelated causes and 1 of adenocarcinoma that originated at the vesicointestinal anastomosis. The actuarial graft survival at 1, 2, and 5 years was 96%, 92%, and 78%, respectively. Complications included symptomatic urinary infection, ureteral stenosis, and lymphocele.
  
  
  CONCLUSIONS
  Augmentation cystoplasty is a safe and effective method to restore function in noncompliant bladders. Renal transplantation can be performed safely after augmentation cystoplasty.
authors.affiliation: Division of Urology, Hospital of Clinics, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: William Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Arap
authors.forename: Ioannis Michel
authors.initials: IM
authors.lastname: Antonopoulos
authors.forename: Elias David
authors.initials: ED
authors.lastname: Neto
authors.forename: Luiz Estevam
authors.initials: LE
authors.lastname: Ianhez
authors.forename: Sami
authors.initials: S
authors.lastname: Arap
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003187:Compliance; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014401:Tuberculosis, Urogenital / Q000601:surgery; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery