title: Low incidence of urinary tract infections following renal transplantation in children with bladder augmentation.
abstract: OBJECTIVE
  Children with end-stage renal disease and bladder dysfunction may require augmentation cystoplasty before kidney transplantation. Previous reports have suggested unacceptable urinary tract infection rates in these immunosuppressed patients. We reviewed our experience in this population.
  
  
  METHODS
  We retrospectively studied patients undergoing augmentation cystoplasty and subsequent renal transplantation by a single surgeon between 1989 and 2007. This cohort was compared with a control group on clean intermittent catheterization who had undergone transplantation without augmentation. Patient demographics, etiology of renal failure, surgical details, surgical/allograft outcomes and occurrence of urinary tract infection were analyzed.
  
  
  RESULTS
  The augmented group included 17 patients with a median age at reconstruction of 6.4 years. Stomach was used in 15 patients and colon in 2. Median time between reconstruction and transplantation was 1.2 years. Median followup after transplantation was 7.7 years. The control group included 17 patients with a median age at transplantation of 10.9 years. Median followup in the controls was 6.1 years. All ureteral reimplantations were antirefluxing. Patients on clean intermittent catheterization were maintained on oral antibiotic suppression and/or gentamicin bladder irrigations. In the augmented group 35 episodes of urinary tract infection were noted, and the number of documented infections per patient-year of followup was 0.22, compared to 32 episodes of urinary tract infection and 0.28 infections per patient-year of followup in the controls. No allograft was lost to infectious complications.
  
  
  CONCLUSIONS
  In our series there was no increase in urinary tract infection rate following renal transplantation in patients with augmented bladders compared to controls. This finding may be due to the use of gastric augmentation, antirefluxing reimplantation and gentamicin irrigations.
authors.affiliation: Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. traxele@wudosis.wustl.edu
authors.forename: Erica
authors.initials: E
authors.lastname: Traxel
authors.forename: William
authors.initials: W
authors.lastname: DeFoor
authors.forename: Eugene
authors.initials: E
authors.lastname: Minevich
authors.forename: Pramod
authors.initials: P
authors.lastname: Reddy
authors.forename: Shumyle
authors.initials: S
authors.lastname: Alam
authors.forename: Deborah
authors.initials: D
authors.lastname: Reeves
authors.forename: Curtis
authors.initials: C
authors.lastname: Sheldon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D016476:Urinary Reservoirs, Continent; D014552:Urinary Tract Infections / Q000453:epidemiology*; D055815:Young Adult