Long-term results of a staged approach: continent urinary diversion in preparation for renal transplantation.
OBJECTIVE
We provide the long-term results of renal transplantation into continent urinary intestinal reservoirs as a planned 2-stage procedure.


METHODS
Between November 1990 and January 2009, 18 patients underwent cadaveric or living related renal transplantation into continent urinary reservoirs (continent cutaneous diversion 16, orthotopic substitution 2). All patients were prospectively followed.


RESULTS
Of these patients 15 are currently free of dialysis. At a mean followup of 89.2 months (range 2 to 188) 13 patients had a serum creatinine ranging from 0.6 to 3.1 mg/dl (mean 1.49) after the first transplantation. Two patients underwent a second transplantation 12 and 122 months after loss of the transplant for renal vein thrombosis and chronic allograft dysfunction, respectively. Two additional patients had to resume hemodialysis 62 and 109 months after renal transplantation. The second transplantation was delayed mainly due to compliance problems. One patient died of fulminant septicemia after laparotomy elsewhere for bowel obstruction with normal renal function before that episode. The continence mechanism needed correction in 3 patients, and 2 further revisions were required for ureteral kinking and lymphocele. The patients with orthotopic substitution (2) voided to completion and showed complete continence. All patients with cutaneous diversion were continent day and night with easy catheterization.


CONCLUSIONS
This study is among the largest single series to date of renal transplantation into continent urinary diversions. Long-term followup confirms that this approach is a safe and socially well accepted treatment option in carefully selected patients.
Kocot
Arkadius
A
Department of Urology and Pediatric Urology, Julius-Maximilians-University Medical School, Würzburg, Germany. arkadius.kocot@gmx.de
Spahn
Martin
M
Loeser
Andreas
A
Lopau
Kai
K
Gerharz
Elmar W
EW
Riedmiller
Hubertus
H
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D013997:Time Factors; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent; D055815:Young Adult