ABSTRACT
A transplant of a portion of bladder with en bloc kidney from a 2-year-old donor was previously reported in a 12-month-old girl due to extremely small bladder. Bilateral kidneys were transplanted en bloc with their ureters connected to a patch of the donor bladder (bladder patch technique). Long-term outcomes and complications of this technique have not been documented. Here, we report a long-term, 17 years, follow of this patient with evaluation of whole bladder functions at 18 years of age. The patient has had no episode of urinary tract infection. Cystoscopy showed a viable transplanted bladder with well perfused mucosa. We observed the native bladder has stretched over time forming more than half of the bladder wall. Urodynamic studies showed preserved bladder compliance at 43 mL/cmH2O and native bladder contractility was preserved. Prolonged voiding time and post-void residual urine were also observed. These findings were suggestive of detrusor underactivity. No reï¬ux across the donor ureterovesical junctions was observed. The recipient was instructed to continue timed voiding and double voiding to empty the bladder. In conclusion, en bloc kidney transplantation with bladder patch is a feasible and safe option in kidney transplant recipients with a small bladder capacity.
ABSTRACT
BACKGROUND: A higher prevalence of bladder cancer is reported in solid organ recipients, and advanced cancer requires radical cystectomy combined with urinary diversion. Surgery is technically challenging in kidney transplant recipients because of urinary tract abnormalities. Here, we describe the use of a robot-assisted approach in a kidney transplant recipient. CASE PRESENTATION: The etiology of the patient's end-stage renal disease was bilateral hypoplastic kidney. The patient started to receive hemodialysis at 19 years of age and underwent living-related kidney transplant at 23 years of age. Thirteen years later, he was diagnosed with invasive urothelial carcinoma and underwent robot-assisted radical cystectomy with extracorporeal neobladder construction under open laparotomy. Surgery was indicated to enhance suture flexibility and dissection of the peribladder tissues. Although the patient had an intraperitoneal infection caused by leakage from the vesicourethral anastomosis site and required drainage of the abscess, his condition stabilized after antibiotic treatment. CONCLUSION: This case outlines the effectiveness of the robot-assisted approach in patients with urinary tract abnormalities, such as kidney transplant recipients.
