Urine Reservoir: Evaluation and Transplant Strategies

  • Ahmad H. BaniHani
  • Christina Ho
  • T. E. Figueroa
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Children with end-stage renal disease (ESRD) are a unique group of patients because of the high incidence of underlying congenital anomalies of the kidney and the urinary tract (CAKUT) seen in about 15–25 % of the cases (Churchill, J Urol 140, 1129–1133, 1988; Zaragoza, J Urol 150, 1463–1466, 1993; Koo, J Urol 161, 240–245, 1999). Congenital urinary tract abnormalities may lead to severe bladder dysfunction. A noncompliant bladder that stores urine in low volumes and under high pressure, often referred to as “valve bladder,” may lead to deterioration of the upper urinary tracts resulting in chronic kidney disease. Children with poorly compliant bladders may fail conservative treatment with initiation of anticholinergic therapy and clean intermittent catheterizations (CIC) and become candidates for reconstructive bladder surgery. The success of kidney transplantation in children with abnormal bladders and end-stage renal disease (ESRD) was controversial. Augmentation cystoplasty with or without a continent catheterizable channel is often done to ensure development of a low-pressure and compliant reservoir. An abnormal native bladder that contributed to renal insufficiency may jeopardize subsequent kidney transplantation resulting in allograft loss. Opponents of kidney transplantation draining into reconstructed bladders often cite increased risk of urinary tract infections (UTIs) in immunocompromised recipients leading to an enhanced immunological response and accelerating graft loss. Some authors have advocated taking down augmented bladders prior to kidney transplantation for the fear of septic complications, graft loss, or even death (Alfrey, Pediatr Nephrol 11, 672–675, 1997). Conversely, other reports have documented that kidney transplantation can be safely drained into reconstructed bladders with comparable graft survival to allografts draining into normal bladders (Nguyen, J Urol 144, 1349–1351, 1990; Sheldon, J Urol 152, 972–975, 1994; Rischmann, Transplant Proc 27, 2427–2429, 1995; Fontaine, J Urol 159, 2110–2113, 1998; Koo, J Urol 161, 240–245, 1999; Hatch, J Urol 165, 2265–2268, 2001; Nahas, Urology 60, 770–774, 2002; Power, J Urol 167, 477–479, 2002; Rigamonti, Transplantation 80, 1435–1440, 2005; Aki, Transplant Proc 47, 1114–1116, 2014). Unfortunately, few controlled studies are available to permit meaningful comparison of outcomes between kidney transplantation in native versus reconstructed bladders.


Chronic kidney disease Children Dysplastic kidneys Lower urinary tract dysfunction Obstructive uropathy Urinary bladder Kidney transplant Dysfunctional voiding Urinary tract infections Vesicoureteral reflux End-stage renal disease Urological malformations 



Congenital anomalies of the kidney and urinary tract


Clean intermittent catheterizations


Chronic kidney disease


Detrusor-sphincter dyssynergia


End-stage renal disease


Lower urinary tract dysfunction


Multicystic dysplastic kidneys


Magnetic resonance imaging


Posterior urethral values


Urinary tract infection


Voiding cystourethrogram


Vesicouretral reflux


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric UrologyAlfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Nemours Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  3. 3.Department of Urology and PediatricsSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA
  4. 4.Sidney Kimmel Medical college-Thomas Jefferson UniversityPhiladelphiaUSA
  5. 5.Cooper Medical School of Rowan UniversityCamdenUSA

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