Djakovic Nenad, Wagener Nina, Adams Judith, Gilfrich Christian, Haferkamp Axel, Pfitzenmaier Jesco, Toenshoff Burkhard, Schmidt Jan, Hohenfellner Markus
Department of Urology and Paediatric Urology, University of Heidelberg, Heidelberg, Germany.
BJU Int. 2009 Jun;103(11):1555-60. doi: 10.1111/j.1464-410X.2008.08264.x. Epub 2008 Dec 8.
OBJECTIVE To report a two-stage protocol for children in whom bladder reconstruction was followed by kidney transplantation, as about a quarter of children requiring a kidney transplantation show significant lower urinary tract dysfunction, and consequently their bladder is unsuitable for a kidney transplant. PATIENTS AND METHODS Twelve children (median age 9.5 years, range 4.2-16.8) with end-stage renal disease had a lower urinary tract reconstruction before kidney transplantation. The cause of bladder dysfunction and renal failure included posterior urethral valves in five, neuropathic bladder in two, prune-belly syndrome in two, anal-rectum and urethral atresia syndrome in one, primary obstructive uropathy in one and caudal regression syndrome in one. Two children were diverted with an ileal conduit; four had a bladder augmentation, and four had a bladder augmentation with additional continent cutaneous stoma. A continent urinary reservoir was constructed in one boy, and one boy had a Mitrofanoff-only procedure. Subsequently, 11 children were transplanted. RESULTS The graft survival rate was 11 of 12 at 1 year and eight of 12 at 5 years. No patient lost the graft related to the reconstructed lower urinary tract. During the median (range) follow-up of 5.4 (1.6-12.5) years all but one child had free drainage of the upper urinary tract. All 10 children who did not have an ileal conduit are continent. CONCLUSION Reconstruction of the lower urinary tract followed by renal transplantation is a safe and efficient approach. It has the advantage of restoring the lower urinary tract before immunosuppressive therapy, and supplies the best possible reservoir for a transplanted kidney.
目的 报告一种针对膀胱重建后进行肾移植的儿童的两阶段方案，因为约四分之一需要肾移植的儿童存在明显的下尿路功能障碍，其膀胱不适于肾移植。患者与方法 12例终末期肾病儿童（中位年龄9.5岁，范围4.2 - 16.8岁）在肾移植前进行了下尿路重建。膀胱功能障碍和肾衰竭的病因包括：后尿道瓣膜症5例、神经源性膀胱2例、梅干腹综合征2例、肛门直肠和尿道闭锁综合征1例、原发性梗阻性尿路病1例、尾椎退化综合征1例。2例儿童采用回肠导管改道术；4例进行膀胱扩大术，4例进行膀胱扩大术并附加可控性皮肤造口术。1例男孩构建了可控性尿液贮器，1例男孩仅进行了米氏术。随后，11例儿童接受了肾移植。结果 1年时移植物存活率为12例中的11例，5年时为12例中的8例。没有患者因重建的下尿路而失去移植物。在中位（范围）5.4（1.6 - 12.5）年的随访期间，除1例儿童外，所有儿童上尿路均引流通畅。所有10例未采用回肠导管改道术的儿童均能自主排尿。结论 先进行下尿路重建再进行肾移植是一种安全有效的方法。它具有在免疫抑制治疗前恢复下尿路功能的优势，并为移植肾提供了最佳的贮尿器。
