Kidney transplantation before or after augmentation cystoplasty in children with high‐pressure neurogenic bladder

• Published in: BJU international Vol. 103; no. 1; pp. 86 - 88
• Main Authors: Basiri, Abbas, Otookesh, Hasan, Hosseini, Rozita, Simforoosh, Nasser, Moghaddam, Seyed Mohammadmehdi Hosseini
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2009; Wiley-Blackwell
• Subjects: Adolescent; Antibiotic Prophylaxis; Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Child; Epidemiologic Methods; Female; Graft Survival; Human bacterial diseases; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Kidney Diseases - complications; Kidney Diseases - surgery; kidney transplantation; Kidney Transplantation - methods; Male; Medical sciences; Nephrology. Urinary tract diseases; Postoperative Complications - prevention & control; Time Factors; Treatment Outcome; Urinary Bladder, Neurogenic - complications; Urinary Bladder, Neurogenic - surgery; urinary bladder/surgery; Urinary Catheterization; Urinary system involvement in other diseases. Miscellaneous; urinary tract infection; Urinary Tract Infections - prevention & control; Urinary tract. Prostate gland; Human; Nervous system diseases; Cystoplasty; Nephrology; Urinary system disease; kidney transplantation; Transplantation; Urinary tract disease; Kidney; Urology; urinary bladder/ surgery; High pressure; Plasty; Urinary tract infection; Treatment; Urinary system; Urinary bladder; Surgery; Neurogenic bladder; Graft; Bladder disease; Neurological disorder; Child
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2008.08081.x

OBJECTIVE To compare the outcome and complications of augmentation cystoplasty before or after renal transplantation in children with neurogenic bladders, with those after kidney transplantation in children with normal bladders. PATIENTS AND METHODS Augmentation cystoplasty preceded transplantation in 21 children (group 1) and after transplantation in 23 (group 2) operated from 1985 to 2006; these two groups were compared with a control group of 45 children with a normal bladder (group 3) who also received a transplant, for kidney function, episodes of urinary tract infection (UTI), surgical and medical complications. RESULTS The mean age of the three groups was 12.9, 13.2 and 13.6 years, respectively (P = 0.2). Graft survival at 1, 3, 5 and 7 years was 90%, 76%, 65% and 43% in group 1, 94%, 61%, 50% and 40% in group 2, and 94%, 87%, 81% and 75% in group 3, respectively, which was not significantly different between groups 1 and 2, but was higher in group 3 (P = 0.03). Febrile UTI was reported in five (24%), seven (30%) and one (2%) patients in groups 1–3, respectively. UTI was significantly less frequent in group 3 (P = 0.01) but was not different between groups 1 and 2. Acute rejection was reported in nine (43%), nine (39%) and 15 (33%) patients in groups 1–3, respectively (P = 0.2). CONCLUSION The timing of cystoplasty in relation to transplantation has no apparent significant effect on the outcome of transplantation.