title: Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation.
abstract: BACKGROUND
  Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences.
  
  
  METHODS
  A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity.
  
  
  RESULTS
  One-year patient and graft survival rates were 100%. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7%) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5% and 84% of expected, respectively.
  
  
  CONCLUSIONS
  In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA.
authors.forename: Sophoclis
authors.initials: S
authors.lastname: Alexopoulos
authors.forename: Amy
authors.initials: A
authors.lastname: Lightner
authors.forename: Waldo
authors.initials: W
authors.lastname: Concepcion
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rose
authors.forename: Kathrine
authors.initials: K
authors.lastname: Salcedo-Concepcion
authors.forename: Oscar
authors.initials: O
authors.lastname: Salvatierra
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057785:Catheters; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014519:Ureterostomy; D001743:Urinary Bladder / Q000601:surgery*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology; D014718:Vesico-Ureteral Reflux / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents