Academic Foundation Year Two, London South Thames Deanery, London, United Kingdom.
Transplantation. 2010 Jun 15;89(11):1299-1307. doi: 10.1097/tp.0b013e3181de5b8c.
In pediatric patients with end-stage renal disease, renal transplantation is the established therapy of choice. The commonest cause is a congenital abnormality of the kidneys and urinary tract, often associated with lower urinary tract dysfunction (LUTD). Historically, such patients were denied transplantation, but it is now widely accepted that transplant outcomes comparable with the non-LUTD population are achievable. Nonetheless, the optimal management of pediatric end-stage renal disease patients with LUTD is unclear, with no guidelines to distinguish between the need for conservative management or surgical reconstruction of the lower urinary tract. Furthermore, the most appropriate surgical procedure and optimal timing of surgical intervention is far from clear. In this review, we outline common conditions that produce LUTD in children; discuss difficulties encountered in assessing the need for surgical treatment; provide an overview of the surgical procedures available; and consider the evidence for and against surgical intervention before, during, and after renal transplantation.
在患有终末期肾病的儿科患者中，肾移植是首选的既定治疗方法。最常见的原因是肾脏和泌尿道的先天性异常，常伴有下尿路功能障碍（LUTD）。从历史上看，此类患者被拒绝进行移植，但现在人们普遍认为，他们可以获得与非 LUTD 人群相当的移植效果。尽管如此，对于患有 LUTD 的儿科终末期肾病患者的最佳管理尚不清楚，也没有指南可以区分保守管理与下尿路重建的需求。此外，最适当的手术程序和最佳手术干预时机仍不清楚。在这篇综述中，我们概述了导致儿童 LUTD 的常见疾病；讨论了在评估手术治疗需求时遇到的困难；提供了可用手术程序的概述；并考虑了在肾移植前、中、后进行手术干预的利弊。
