Augmentation cystoplasty in renal transplantation: a good and safe option--experience with 25 cases.
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.
Nahas
William Carlos
WC
Division of Urology, Hospital of Clinics, University of São Paulo School of Medicine, São Paulo, Brazil.
Mazzucchi
Eduardo
E
Arap
Marco Antonio
MA
Antonopoulos
Ioannis Michel
IM
Neto
Elias David
ED
Ianhez
Luiz Estevam
LE
Arap
Sami
S
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