Renal transplantation in children with augmentation enterocystoplasty.
BACKGROUND
We report our experience with renal transplantation in patients with severe bladder dysfunction who underwent prior augmentation cystoplasty.


METHODS
Among 58 pediatric patients, three underwent bladder augmentation prior to renal transplantation. The patients' ages at transplantation were 10, 13, and 17. The etiologies of bladder dysfunction were posterior urethral valves in two patients and contracted bladder in one patient. Vesicoureteral reflux was concomitantly present in three patients. Pretransplant ileocystoplasty was created in two patients and gastrocystoplasty in one patient. All patients received kidneys from cadaveric donors and were treated with calcineurin-based immunosuppressive therapy.


RESULTS
The patients had normal renal function without hydronephrosis of the transplanted kidney at 13, 22, 49 months follow-up. No patients had morbidity due to technical complications. All the patients were continent. Two of three patients required clean intermittent catheterization from a Mitrofanoff conduit, while one patient spontaneously voids without significant residual urine. Urinary tract infections observed in two patients were successfully treated without any permanent deterioration in graft kidney function.


CONCLUSIONS
Our data suggest that augmentation cystoplasty is a safe and effective option to treat patients with end-stage renal disease undergoing kidney transplantation. Experience of the transplantation team with a qualified pediatric urologist is essential due to the potentially high risk of surgical complications during the long term management of these patients.
Department of Urology, Hacettepe University Faculty of Medicine Hospital, Ankara, Turkey. ftuncayaki@yahoo.com
F T
FT
Aki
N
N
Besbas
O
O
Ozcan
A
A
Bakkaloglu
I
I
Erkan
M
M
Bakkaloglu
S
S
Tekgul
D000293:Adolescent; D002648:Child; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery