Renal transplantation experience following endoscopic treatment of vesicoureteral reflux.
The most efficacious treatment for end-stage renal disease is renal transplantation. Because high-grade vesicoureteral reflux forecasts potential future complications, the patients studied were subjected to bilateral nephroureterectomy before transplantation. The aim of this study was to investigate the posttransplantation results of a subureteral injection performed before transplantation to treat high-grade vesicoureteral reflux in end-stage renal disease patients. Renal transplantation was performed on 14 of 52 end-stage renal disease patients that had undergone prior subureteral injection. Subureteral injection had been performed in 24 refluxing renal units of these 14 patients. Ten patients had bilateral and 4 patients unilateral reflux. The treatment criterion was reflux of at least grade III; however, when low-grade reflux was present in the contralateral renal unit, it was also treated during the same session. Success was determined as no (complete) or decrease to grade I (partial) reflux. The patient ages ranged between 13 and 46 years (mean 29.3 years). The reflux resolved in 20 of 24 renal units (83%) and was reduced to grade I in 3 of the others (12%), namely resulting in a total response rate of 95%. Except for 1 patient who was lost to follow-up, the other recipients were observed for 6 to 47 months (mean 23 months). Only 1 patient experienced symptomatic urinary tract infection or asymptomatic bacteriuria after renal transplantation. Acute rejection occurred in 5 and chronic rejection in 3 patients. In conclusion, subureteral injection instead of nephroureterectomy seems to be an efficient and minimally invasive alternative for renal transplant recipients with high-grade vesicoureteral reflux.
Aygün
C
C
Department of Urology, Başkent University, Faculty of Medicine, Ankara, Turkey. ccaygun@yahoo.com
Ozer
C
C
Dirim
A
A
Tekin
M I
MI
Gören
M R
MR
Peşkircioğlu
C L
CL
Ozkardes
H
H
Haberal
M
M
D000293:Adolescent; D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000601:surgery*