Kidney transplantation in children with urinary diversion or bladder augmentation

D. A. Hatch, M. A. Koyle, L. S. Baskin, M. R. Zaontz, M. W. Burns, W. F. Tarry, J. M. Barry, P. Belitsky, R. J. Taylor

    Research output: Contribution to journalArticle

    83 Citations (Scopus)

    Abstract

    Purpose: Urinary tract anomalies or dysfunction leaves the bladder unsuitable for urine drainage in a significant proportion of children presenting for kidney transplantation. We reviewed a multi-institutional experience to determine the ramifications of kidney transplantation in children with bladder augmentation or urinary diversion. Materials and Methods: During a 28-year period 18 boys and 12 girls 1.7 to 18 years old (mean age 12.1) received 31 kidney transplants. Cause of end stage renal disease was renal dysplasia in 8 cases, posterior urethral valves in 5, obstructive uropathy in 5, neurogenic bladder/chronic pyelonephritis in 4, spina bifida/chronic pyelonephritis in 3, prune belly syndrome in 3 and reflux in 2. Results: Of the patients 17 had augmented bladder (ileum 9, ureter 5, sigmoid 2 and stomach 1), 12 had incontinent urinary conduits (8 ileum, 6 colon) and 1 had a continent urinary reservoir. Surgical complications included 1 case each of stomal stenosis, stomal prolapse, renal artery stenosis, urine leak, enterovesical fistula and wound dehiscence. Medical complications included urinary tract infection in 21 cases and metabolic acidosis in 5. A bladder stone developed in 1 patient. There was no correlation between the incidence of symptomatic urinary tract infections and type of urinary drainage. Acidosis was more common in patients with augmented bladder (4 of 17 versus 1 of 14) but there was no correlation between the bowel segment used and the occurrence of acidosis. Graft survival was 90% at 1 year, 78% at 5 years and 60% at 10 years. Etiology of graft loss included chronic rejection in 6 cases, noncompliance in 4 and acute rejection in 1. There were no deaths. Conclusions: Drainage of transplanted kidneys into an augmented bladder or urinary conduit is an appropriate management strategy when the native bladder is unsuitable or absent. Patients with kidney transplants drained into augmented bladder or urinary conduit are at increased risk for urine infection. Graft survival is not adversely affected compared to historical controls when a kidney transplant is drained into a urinary conduit or augmented bladder.

    Original languageEnglish (US)
    Pages (from-to)2265-2268
    Number of pages4
    JournalJournal of Urology
    Volume165
    Issue number6 II SUPPL.
    StatePublished - 2001

    Fingerprint

    Urinary Diversion
    Kidney Transplantation
    Urinary Bladder
    Kidney
    Acidosis
    Transplants
    Drainage
    Pyelonephritis
    Urine
    Graft Survival
    Ileum
    Urinary Tract Infections
    Continent Urinary Reservoirs
    Prune Belly Syndrome
    Urinary Bladder Calculi
    Neurogenic Urinary Bladder
    Renal Artery Obstruction
    Spinal Dysraphism
    Prolapse
    Sigmoid Colon

    Keywords

    • Bladder
    • Kidney transplantation
    • Urinary diversion

    ASJC Scopus subject areas

    • Urology

    Cite this

    Hatch, D. A., Koyle, M. A., Baskin, L. S., Zaontz, M. R., Burns, M. W., Tarry, W. F., ... Taylor, R. J. (2001). Kidney transplantation in children with urinary diversion or bladder augmentation. Journal of Urology, 165(6 II SUPPL.), 2265-2268.

    Kidney transplantation in children with urinary diversion or bladder augmentation. / Hatch, D. A.; Koyle, M. A.; Baskin, L. S.; Zaontz, M. R.; Burns, M. W.; Tarry, W. F.; Barry, J. M.; Belitsky, P.; Taylor, R. J.

    In: Journal of Urology, Vol. 165, No. 6 II SUPPL., 2001, p. 2265-2268.

    Research output: Contribution to journalArticle

    Hatch, DA, Koyle, MA, Baskin, LS, Zaontz, MR, Burns, MW, Tarry, WF, Barry, JM, Belitsky, P & Taylor, RJ 2001, 'Kidney transplantation in children with urinary diversion or bladder augmentation', Journal of Urology, vol. 165, no. 6 II SUPPL., pp. 2265-2268.
    Hatch DA, Koyle MA, Baskin LS, Zaontz MR, Burns MW, Tarry WF et al. Kidney transplantation in children with urinary diversion or bladder augmentation. Journal of Urology. 2001;165(6 II SUPPL.):2265-2268.
    Hatch, D. A. ; Koyle, M. A. ; Baskin, L. S. ; Zaontz, M. R. ; Burns, M. W. ; Tarry, W. F. ; Barry, J. M. ; Belitsky, P. ; Taylor, R. J. / Kidney transplantation in children with urinary diversion or bladder augmentation. In: Journal of Urology. 2001 ; Vol. 165, No. 6 II SUPPL. pp. 2265-2268.
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    abstract = "Purpose: Urinary tract anomalies or dysfunction leaves the bladder unsuitable for urine drainage in a significant proportion of children presenting for kidney transplantation. We reviewed a multi-institutional experience to determine the ramifications of kidney transplantation in children with bladder augmentation or urinary diversion. Materials and Methods: During a 28-year period 18 boys and 12 girls 1.7 to 18 years old (mean age 12.1) received 31 kidney transplants. Cause of end stage renal disease was renal dysplasia in 8 cases, posterior urethral valves in 5, obstructive uropathy in 5, neurogenic bladder/chronic pyelonephritis in 4, spina bifida/chronic pyelonephritis in 3, prune belly syndrome in 3 and reflux in 2. Results: Of the patients 17 had augmented bladder (ileum 9, ureter 5, sigmoid 2 and stomach 1), 12 had incontinent urinary conduits (8 ileum, 6 colon) and 1 had a continent urinary reservoir. Surgical complications included 1 case each of stomal stenosis, stomal prolapse, renal artery stenosis, urine leak, enterovesical fistula and wound dehiscence. Medical complications included urinary tract infection in 21 cases and metabolic acidosis in 5. A bladder stone developed in 1 patient. There was no correlation between the incidence of symptomatic urinary tract infections and type of urinary drainage. Acidosis was more common in patients with augmented bladder (4 of 17 versus 1 of 14) but there was no correlation between the bowel segment used and the occurrence of acidosis. Graft survival was 90{\%} at 1 year, 78{\%} at 5 years and 60{\%} at 10 years. Etiology of graft loss included chronic rejection in 6 cases, noncompliance in 4 and acute rejection in 1. There were no deaths. Conclusions: Drainage of transplanted kidneys into an augmented bladder or urinary conduit is an appropriate management strategy when the native bladder is unsuitable or absent. Patients with kidney transplants drained into augmented bladder or urinary conduit are at increased risk for urine infection. Graft survival is not adversely affected compared to historical controls when a kidney transplant is drained into a urinary conduit or augmented bladder.",
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    T1 - Kidney transplantation in children with urinary diversion or bladder augmentation

    AU - Hatch, D. A.

    AU - Koyle, M. A.

    AU - Baskin, L. S.

    AU - Zaontz, M. R.

    AU - Burns, M. W.

    AU - Tarry, W. F.

    AU - Barry, J. M.

    AU - Belitsky, P.

    AU - Taylor, R. J.

    PY - 2001

    Y1 - 2001

    N2 - Purpose: Urinary tract anomalies or dysfunction leaves the bladder unsuitable for urine drainage in a significant proportion of children presenting for kidney transplantation. We reviewed a multi-institutional experience to determine the ramifications of kidney transplantation in children with bladder augmentation or urinary diversion. Materials and Methods: During a 28-year period 18 boys and 12 girls 1.7 to 18 years old (mean age 12.1) received 31 kidney transplants. Cause of end stage renal disease was renal dysplasia in 8 cases, posterior urethral valves in 5, obstructive uropathy in 5, neurogenic bladder/chronic pyelonephritis in 4, spina bifida/chronic pyelonephritis in 3, prune belly syndrome in 3 and reflux in 2. Results: Of the patients 17 had augmented bladder (ileum 9, ureter 5, sigmoid 2 and stomach 1), 12 had incontinent urinary conduits (8 ileum, 6 colon) and 1 had a continent urinary reservoir. Surgical complications included 1 case each of stomal stenosis, stomal prolapse, renal artery stenosis, urine leak, enterovesical fistula and wound dehiscence. Medical complications included urinary tract infection in 21 cases and metabolic acidosis in 5. A bladder stone developed in 1 patient. There was no correlation between the incidence of symptomatic urinary tract infections and type of urinary drainage. Acidosis was more common in patients with augmented bladder (4 of 17 versus 1 of 14) but there was no correlation between the bowel segment used and the occurrence of acidosis. Graft survival was 90% at 1 year, 78% at 5 years and 60% at 10 years. Etiology of graft loss included chronic rejection in 6 cases, noncompliance in 4 and acute rejection in 1. There were no deaths. Conclusions: Drainage of transplanted kidneys into an augmented bladder or urinary conduit is an appropriate management strategy when the native bladder is unsuitable or absent. Patients with kidney transplants drained into augmented bladder or urinary conduit are at increased risk for urine infection. Graft survival is not adversely affected compared to historical controls when a kidney transplant is drained into a urinary conduit or augmented bladder.

    AB - Purpose: Urinary tract anomalies or dysfunction leaves the bladder unsuitable for urine drainage in a significant proportion of children presenting for kidney transplantation. We reviewed a multi-institutional experience to determine the ramifications of kidney transplantation in children with bladder augmentation or urinary diversion. Materials and Methods: During a 28-year period 18 boys and 12 girls 1.7 to 18 years old (mean age 12.1) received 31 kidney transplants. Cause of end stage renal disease was renal dysplasia in 8 cases, posterior urethral valves in 5, obstructive uropathy in 5, neurogenic bladder/chronic pyelonephritis in 4, spina bifida/chronic pyelonephritis in 3, prune belly syndrome in 3 and reflux in 2. Results: Of the patients 17 had augmented bladder (ileum 9, ureter 5, sigmoid 2 and stomach 1), 12 had incontinent urinary conduits (8 ileum, 6 colon) and 1 had a continent urinary reservoir. Surgical complications included 1 case each of stomal stenosis, stomal prolapse, renal artery stenosis, urine leak, enterovesical fistula and wound dehiscence. Medical complications included urinary tract infection in 21 cases and metabolic acidosis in 5. A bladder stone developed in 1 patient. There was no correlation between the incidence of symptomatic urinary tract infections and type of urinary drainage. Acidosis was more common in patients with augmented bladder (4 of 17 versus 1 of 14) but there was no correlation between the bowel segment used and the occurrence of acidosis. Graft survival was 90% at 1 year, 78% at 5 years and 60% at 10 years. Etiology of graft loss included chronic rejection in 6 cases, noncompliance in 4 and acute rejection in 1. There were no deaths. Conclusions: Drainage of transplanted kidneys into an augmented bladder or urinary conduit is an appropriate management strategy when the native bladder is unsuitable or absent. Patients with kidney transplants drained into augmented bladder or urinary conduit are at increased risk for urine infection. Graft survival is not adversely affected compared to historical controls when a kidney transplant is drained into a urinary conduit or augmented bladder.

    KW - Bladder

    KW - Kidney transplantation

    KW - Urinary diversion

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