Department of Surgery, Stanford University, Stanford, CA, USA.
Transplantation. 2011 Feb 27;91(4):452-6. doi: 10.1097/TP.0b013e318204381a.
Children with small capacity, defunctionalized urinary bladders present unique operative challenges. Thus, traditional practice has included pretransplant bladder augmentation, but this has several adverse consequences.
A single-institutional, retrospective review from January 1, 2004 to December 31, 2008 was conducted. Twelve pediatric patients, whom had not undergone pretransplant bladder augmentation, did not have neurogenic bladders or require preoperative catheterization, and a small capacity defunctionalized bladders were included. All were managed by the same surgeon with a previously described ureteral implantation, and a 7F ureteral stent attached to a large diameter suprapubic catheter was removed in a joint manner without cystoscopy at 2 weeks. Data were collected on patient and graft survival, rejection episodes, urinary tract infection (UTI) requiring antibiotics, grade of vesicoureteral reflux, and posttransplant bladder capacity.
One-year patient and graft survival rates were 100%. One patient experienced a clinical rejection episode, which was successfully treated. Five patients (41.7%) had a UTI requiring abx treatment within the first postoperative year, but at 1 year, all patients had sterile urinary tracts. After removal of suprapubic catheters and ureteral stents, all patients were able to void spontaneously. Seven patients had no posttransplant ureteral reflux, three had grade 1 reflux, and two had grade 3 reflux (both successfully treated). The average age estimated pretransplant bladder and 1 year posttransplant bladder capacity was 14.5% and 84% of expected, respectively.
In pediatric end-stage renal disease patients with a small capacity defunctionalized bladder, it is reasonable to proceed with kidney transplantation without pretransplant bladder augmentation, thus avoiding an unnecessary surgery.
小容量、无功能膀胱的儿童存在独特的手术挑战。因此，传统做法包括移植前膀胱扩大术，但这有几个不利后果。
回顾性分析了 2004 年 1 月 1 日至 2008 年 12 月 31 日期间的单个机构资料。纳入了 12 例未接受移植前膀胱扩大术、无神经源性膀胱或需要术前置管、且容量小、无功能的膀胱的儿科患者。所有患者均由同一位外科医生管理，采用先前描述的输尿管植入术，将 7F 输尿管支架与大直径耻骨上导管相连，2 周时无需膀胱镜检查即可联合取出。收集患者和移植物存活率、排斥反应发作、需要抗生素治疗的尿路感染 (UTI)、膀胱输尿管反流程度和移植后膀胱容量的数据。
1 年患者和移植物存活率均为 100%。1 例患者发生临床排斥反应，经治疗成功。5 例（41.7%）患者在术后 1 年内发生 UTI，需要使用抗生素治疗，但在 1 年内，所有患者的尿液均无菌。取出耻骨上导管和输尿管支架后，所有患者均能自行排尿。7 例患者无移植后输尿管反流，3 例患者存在 1 级反流，2 例患者存在 3 级反流（均成功治疗）。移植前膀胱和移植后 1 年膀胱容量的平均估计值分别为预计值的 14.5%和 84%。
对于小容量无功能膀胱的儿童终末期肾病患者，在不进行移植前膀胱扩大术的情况下进行肾移植是合理的，从而避免了不必要的手术。
