Comparison of Renal Transplantation Outcomes in Children With and Without Bladder Dysfunction. A Customized Approach Equals the Difference
| Autor: | Ioannis M. Antonopoulos, Elias David-Neto, L M. Pereira, William C. Nahas, Affonso C. Piovesan, Miguel Srougi, Hideki Kanashiro, Luiz Estevam Ianhez |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Urology medicine.medical_treatment Urinary system End stage renal disease Cohort Studies Ureter Mitrofanoff procedure Humans Medicine Child Retrospective Studies Urinary bladder business.industry Urinary Bladder Diseases Infant Urination Disorders medicine.disease Kidney Transplantation Surgery Transplantation Treatment Outcome medicine.anatomical_structure Bladder augmentation Child Preschool Kidney Failure Chronic Urologic Surgical Procedures Female Urologic disease business |
| Zdroj: | Journal of Urology. 179:712-716 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | We examined the development of urological abnormalities in a group of pediatric renal transplant recipients.We reviewed 211 patients younger than 19 years who underwent 226 renal transplants. Three groups of patients were studied-136 children with end stage renal disease due to a nonurological cause (group 1), 56 children with a urological disorder but with an adequate bladder (group 2a) and 19 children with lower urinary tract dysfunction and/or inadequate bladder drainage (group 2b). A total of 15 children in group 2b underwent bladder augmentation (ureterocystoplasty in 6, enterocystoplasty in 9), 2 underwent continent urinary diversion, 1 underwent autoaugmentation and 1 underwent a Mitrofanoff procedure at the bladder for easier drainage. Kidney transplantation was performed in the classic manner by extraperitoneal access, and whenever possible the ureter was reimplanted using an antireflux procedure.At a mean followup of 75 months 13 children had died, 59 grafts were lost and 15 children had received a second transplant. Two patients in group 2a required a complementary urological procedure to preserve renal function (1 enterocystoplasty, 1 vesicostomy). A total of 12 major surgical complications occurred in 226 kidney transplants (5.3%), with a similar incidence in all groups. The overall graft survival at 5 years was 75%, 74% and 84%, respectively, in groups 1, 2a and 2b.With individualized treatment children with severely inferior lower urinary tract function may undergo renal transplantation with a safe and adequate outcome. |
| Databáze: | OpenAIRE |
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