Comparison of enterocystoplasty and ureterocystoplasty before kidney transplantation

ABSTRACT

Augmentation cystoplasty before or after renal transplantation is an option for patients with end-stage renal disease who are candidates for renal transplantation and have low capacity and poorly compliant bladders. To compare two surgical methods of bladder augmentation-enterocystoplasty [EC] and ureterocystoplasty [UC]-before kidney transplantation, and their outcome with that in kidney recipients who had normal bladder function. During a 20-year period [1988-2008], 1406 renal transplantation were performed in our center by our team. In 16 patients having a mean age of 18.8 years, EC [group A] and in 8 with mean age of 11.5 years, UC [group B] were performed before renal transplantation. These two groups were compared with a control group of 30 recipients with normal bladder [group C] with mean age of 15.6 years, for kidney function, graft and patient survival, and the frequency of urinary tract infection [UTI]. There was normal graft function in 11 of group A, 7 of group B, and 24 of group C patients, during a mean follow-up of 73.1 months. The mean +/- SD serum creatinine in follow-up was 1.72 +/- 0.31, 1.37 +/- 0.13 and 1.33 +/- 0.59 mg/dL in groups A, B and C, respectively. No statistically significant differences were observed among the 3 studied groups in terms of 1-, 5- and 10-year graft and patient survivals. Number of episodes of febrile UTI requiring hospitalization was 23, 6 and 2 in groups A, B and C, respectively. UTI and urosepsis were significantly more frequent in group A than groups B [p=0.025] and C [p=0.001]; no significant difference was observed in the frequency between groups B and C [p=0.310]. Both EC and UC are equally recommended before renal transplantation for reconstruction of the lower urinary tract; use of each method should be individualized depending on specific conditions of recipient