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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)

Abstract

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.

Keywords

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 

Abbreviations

CAKUT

Congenital anomalies of the kidney and urinary tract

CIC

Clean intermittent catheterizations

CKD

Chronic kidney disease

DSD

Detrusor-sphincter dyssynergia

ESRD

End-stage renal disease

LUTD

Lower urinary tract dysfunction

MCDK

Multicystic dysplastic kidneys

MRI

Magnetic resonance imaging

PUV

Posterior urethral values

UTI

Urinary tract infection

VCUG

Voiding cystourethrogram

VUR

Vesicouretral reflux

References

  1. Aki F, Aydin A, Dogan H et al (2014) Does lower urinary tract status affect renal transplantation outcomes in children? Transplant Proc 47:1114–1116CrossRefGoogle Scholar
  2. Alexopoulos S, Lightner A, Concepcion W et al (2011) Pediatric kidney recipients with small capacity, defunctionalized urinary bladders receiving adult-sized kidney without prior bladder augmentation. Transplantation 91:452–456PubMedGoogle Scholar
  3. Alfrey EJ, Salvatierra O, Tanney DC et al (1997) Bladder augmentation can be problematic with renal failure and transplantation. Pediatr Nephrol 11:672–675CrossRefPubMedGoogle Scholar
  4. Broniszczak D, Ismail H, Nachulewicz P et al (2010) Kidney transplantation in children with bladder augmentation or ileal conduit diversion. Eur J Pediatr Surg 20:5–10CrossRefPubMedGoogle Scholar
  5. Cuvelier R, Pirson Y, Alexandre GP et al (1985) Late urinary tract infection after transplantation: prevalence, predisposition and morbidity. Nephron 40:76–78CrossRefPubMedGoogle Scholar
  6. Djakovic N, Wagener N, Adams J et al (2009) Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation. BJU Int 103:1555–1560CrossRefPubMedGoogle Scholar
  7. Dunn SP, Vinocur CD, Hanevold C et al (1987) Pyelonephritis following pediatric renal transplant: increased incidence with vesicoureteral reflux. J Pediatr Surg 22:1095–1099CrossRefPubMedGoogle Scholar
  8. Engelstein D, Dorfman B, Yussim A et al (1997) A critical appraisal of vesicoureteral reflux in long-term renal transplantation recipients: prospective study. Transplant Proc 29:136–137CrossRefPubMedGoogle Scholar
  9. Fairhurst J, Rubin C, Hyde I et al (1991) Bladder capacity in infants. J Pediatr Surg 26:55–57CrossRefPubMedGoogle Scholar
  10. Favi E, Spagnoletti G, Valentini AL et al (2009) Long-term clinical impact of vesicoureteral reflux in kidney transplantation. Transplant Proc 41:1218–1220CrossRefPubMedGoogle Scholar
  11. Fontaine E, Gagnadoux M, Niauder P et al (1998) Renal transplantation in children with augmentation cystoplasty: long-term results. J Urol 159:2110–2113CrossRefPubMedGoogle Scholar
  12. Hatch D, Koyle M, Baskin L et al (2001) Kidney transplantation in children with urinary diversion or bladder augmentation. J Urol 165:2265–2268CrossRefPubMedGoogle Scholar
  13. Herthelius M, Oborn H (2007) Urinary tract infections and bladder dysfunction after renal transplantation in children. J Urol 177:1883–1886CrossRefPubMedGoogle Scholar
  14. Khositseth S, Askiti V, Nevins T et al (2007) Increased urologic complications in children after kidney transplants for obstructive and reflux uropathy. Am J Transplant 7:2152–2157CrossRefPubMedGoogle Scholar
  15. Koff S (1983) Estimating bladder capacity in children. Urology 21:248CrossRefPubMedGoogle Scholar
  16. Koo H, Bunchman T, Flynn J et al (1999) Renal transplantation in children with severe lower urinary tract dysfunction. J Urol 161:240–245CrossRefPubMedGoogle Scholar
  17. Kryger J, Gonzalez R, Barthold J (2000) Surgical management of urinary incontinence in children with neurogenic sphincteric incompetence. J Urol 163:256–263CrossRefPubMedGoogle Scholar
  18. Lee S, Moon HH, Kim TS et al (2013) Presence of vesicoureteral reflux in the graft kidney does not adversely affect long-term graft outcome in kidney transplant recipients. Transplant Proc 45:2984–2987CrossRefPubMedGoogle Scholar
  19. Luke P, Herz D, Bellinger M et al (2003) Long-term results of pediatric renal transplantation into a dysfunctional lower urinary tract. Transplantation 76:1578–1582CrossRefPubMedGoogle Scholar
  20. Nahas W, Mazzucchi E, Arap M et al (2002) Augmentation cystoplasty in renal transplantation: a good and safe option- experience with 25 cases. Urology 60:770–774CrossRefPubMedGoogle Scholar
  21. Nguyen D, Reinberg Y, Gonzalez R et al (1990) Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study. J Urol 144:1349–1351CrossRefPubMedGoogle Scholar
  22. North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) (2014) 2014 Annual transplant report, Rockville: The EMMES Corporation. Available at: https://web.emmes.com/study/ped/annlrept/annualrept2014.pdf
  23. Penna F, Elder J (2011) CKD and bladder problems in children. Adv Chronic Kidney Dis 18:362–369CrossRefPubMedGoogle Scholar
  24. Peters C (2015) Urological considerations in pediatric renal transplantation. In: Wein A, Kavoussi L, Partin A, Peters C (eds) Campbell-Walsh urology, 11th edn. Elsevier, Philadelphia, pp 3528–3537Google Scholar
  25. Power R, O’Malley K, Little D et al (2002) Long-term followup of cadaveric renal transplantation in patients with spina bifida. J Urol 167:477–479CrossRefPubMedGoogle Scholar
  26. Ranghino A, Segoloni G, Lasaponara F et al (2015) Lymphatic disorders after renal transplantation: new insights for an old complication. Clin Kidney J 8:615–622CrossRefPubMedPubMedCentralGoogle Scholar
  27. Rigamonti W, Capizzi A, Zachello G et al (2005) Kidney transplantation into bladder augmentation or urinary diversion: long-term results. Transplantation 80:1435–1440CrossRefPubMedGoogle Scholar
  28. Rischmann P, Malavaud B, Bitker M et al (1995) Results of 51 renal transplants with the use of bowel conduits in patients with impaired bladder function: a retrospective multicenter study. Transplant Proc 27:2427–2429PubMedGoogle Scholar
  29. Rossi V, Torino G, Gerocarni Nappo S et al (2016) Urological complications following kidney transplantation in pediatric age: a single-center experience. Pediatr Transplant 20:485–491CrossRefPubMedGoogle Scholar
  30. Sheldon C, Gonzalez R, Burns M et al (1994) Renal transplantation into the dysfunctional bladder: the role of adjunctive bladder reconstruction. J Urol 152:972–975CrossRefPubMedGoogle Scholar
  31. Shokeir A, Osman Y, Ali-El-Dein B et al (2005) Surgical complications in live-donor pediatric and adolescent renal transplantation: study of risk factors. Pediatr Transplant 9:33–38CrossRefPubMedGoogle Scholar
  32. Smith K, Windsperger A, Alanee S et al (2010) Risk factors and treatment success for ureteral obstruction after pediatric renal transplantation. J Urol 183:317–322CrossRefPubMedGoogle Scholar
  33. Szwed A, Maxwell D, Kleit S et al (1973) Angiotensin II, diuretics, and thoracic duct lymph flow in the dog. Am J Physiol 224:705–708PubMedGoogle Scholar
  34. Taghizadeh A, Desai D, Ledermann S et al (2007) Renal transplantation or bladder augmentation first? A comparison of complications and outcomes in children. BJU Int 100:1365–1370CrossRefPubMedGoogle Scholar

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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