title: Pre-transplant management of valve bladder: a critical literature review.
abstract: OBJECTIVE
  Indications, timing and problems related to augmentation cystoplasty (AC), in the context of posterior urethral valves (PUV) and renal transplantation (RT) are ill defined. Associated bladder dysfunction (BD) is not a stable condition and may cause the loss of the renal graft. Polyuria, accentuates BD and seems to improve after RT. The objective of this research is to critically review the available literature, aiming to rationalize the treatment of PUV with BD in the context of end stage renal disease (ESRD).
  
  
  METHODS
  A thorough literature review was performed. Pertinent papers were, critically analyzed and classified according to the level of evidence.
  
  
  RESULTS
  Data relating to PUV, RT and AC showed low levels of evidence. Results of RT in PUV cases with adequate management of BD were comparable to those suffering from other causes of ESRD. Bladder function can recover spontaneously after urinary undiversion. There were no established criteria to indicate AC in the context of ESRD and PUV or to define the ideal protocol to treat associated vesicoureteral reflux (VUR). Urinary tract infections (UTIs) were more frequent in transplanted PUV patients; this is possibly related to the inadequate control of BD, especially after AC. AC is feasible after RT with outcomes comparable to preemptive ones.
  
  
  CONCLUSIONS
  AC increases the risk of UTI after RT. Preemptive AC should be constructed only if the risks associated with increased bladder pressures exceed those associated with AC. Adequate management of BD is essential to improve bladder function and to minimize UTIs. AC is feasible after RT, with complication rates similar to the ones performed beforehand. Since a considerable number of PUV patients with high-pressure bladders eventually develop myogenic failure, it seems logical to postponing AC in this population, as long as they are under close surveillance.
authors.affiliation: Division of Pediatric Surgery/Urology, Federal Fluminense University, Antônio Pedro University Hospital, Rio de Janeiro, Brazil. Electronic address: lisieuxeyerdejesus@gmail.com.
authors.forename: L E
authors.initials: LE
authors.lastname: Jesus
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Sidra Medical and Research Center, Doha, Qatar.
authors.forename: J L
authors.initials: JL
authors.lastname: Pippi Salle
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery*
keywords: Augmentation cystoplasty; Bladder dysfunction; Kidney transplant; Posterior urethral valves; Valve bladder