[Bladder augmentation and urinary diversion in kidney transplant candidates].
OBJECTIVE
Kidney transplantation (KT) is the treatment of choice for patients with end stage renal disease (ESRD). 6% of the patients develop ESRD due to congenital or acquired lower urinary tract anomalies, which sometimes imply the need of an additional surgical procedure to make the patient suitable for transplantation.


METHODS
We review 6 cases of KT receptors (three of them pediatric) to whom some kind of reconstruction of the lower urinary tract with bowel was performed over the last 10 years.


RESULTS
Most frequent etiologies: neurogenic bladder (3), small and contracted bladder after genitourinary tuberculosis, urethral valves, and transitional cell carcinoma with radical cystoprostatectomy and bilateral nephrectomy. Surgical techniques: Bladder augmentation with colon (3), Bricker's defunctionalized ileal loop (2), and Goodwin 's ileal bladder augmentation; all of them were performed between 8 and 147 months before transplant.


RESULTS
UTI in 2 patients. Recurrent stenosis of the ileal loop in one patient who required endoscopic balloon dilation and stent placement in the stenotic segment with poor results and finally requiring loop reconstruction. Another patient developed stenosis of the ureteroneocystostomy anastomosis and reimplant was performed. All of them had good outcome. One case had a subacute kidney rejection episode with good response to steroids. No graft was lost. Current serum creatinine values are between 0.69 and 2.6.


CONCLUSIONS
The use of bowel in patients with pathologic bladders is as safe method to allow these patients to receive a kidney transplant when bladder rehabilitation has not been possible with conservative measures.
Argüelles Salido
Enrique
E
Servicio de Urología, Hospital Universitario Virgen del Rocío, Sevilla, España. earguelles@telefonica.net
Barrero Candau
Rafael
R
Torrubia Romero
Francisco Javier
FJ
Cruz Navarro
Natalio
N
Leal Arenas
José
J
Montañés Medina
Pedro
P
D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods