Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
J Urol. 2011 Aug;186(2):667-71. doi: 10.1016/j.juro.2011.03.155. Epub 2011 Jun 17.
Children with end-stage renal disease and bladder dysfunction may require augmentation cystoplasty before kidney transplantation. Previous reports have suggested unacceptable urinary tract infection rates in these immunosuppressed patients. We reviewed our experience in this population.
We retrospectively studied patients undergoing augmentation cystoplasty and subsequent renal transplantation by a single surgeon between 1989 and 2007. This cohort was compared with a control group on clean intermittent catheterization who had undergone transplantation without augmentation. Patient demographics, etiology of renal failure, surgical details, surgical/allograft outcomes and occurrence of urinary tract infection were analyzed.
The augmented group included 17 patients with a median age at reconstruction of 6.4 years. Stomach was used in 15 patients and colon in 2. Median time between reconstruction and transplantation was 1.2 years. Median followup after transplantation was 7.7 years. The control group included 17 patients with a median age at transplantation of 10.9 years. Median followup in the controls was 6.1 years. All ureteral reimplantations were antirefluxing. Patients on clean intermittent catheterization were maintained on oral antibiotic suppression and/or gentamicin bladder irrigations. In the augmented group 35 episodes of urinary tract infection were noted, and the number of documented infections per patient-year of followup was 0.22, compared to 32 episodes of urinary tract infection and 0.28 infections per patient-year of followup in the controls. No allograft was lost to infectious complications.
In our series there was no increase in urinary tract infection rate following renal transplantation in patients with augmented bladders compared to controls. This finding may be due to the use of gastric augmentation, antirefluxing reimplantation and gentamicin irrigations.
患有终末期肾病和膀胱功能障碍的儿童可能需要在肾移植前进行膀胱扩大术。先前的报告表明，这些免疫抑制患者的尿路感染率较高。我们回顾了我们在这一人群中的经验。
我们回顾性地研究了 1989 年至 2007 年间由一位外科医生进行的膀胱扩大术和随后肾移植的患者。该队列与未行膀胱扩大术而接受移植的清洁间歇导尿对照组进行比较。分析了患者的人口统计学、肾衰竭的病因、手术细节、手术/移植物的结果以及尿路感染的发生情况。
扩大组包括 17 例患者，重建时的中位年龄为 6.4 岁。15 例患者使用胃，2 例患者使用结肠。重建与移植之间的中位时间为 1.2 年。移植后中位随访时间为 7.7 年。对照组包括 17 例患者，移植时的中位年龄为 10.9 岁。对照组的中位随访时间为 6.1 年。所有输尿管再植均为抗反流。清洁间歇导尿的患者接受口服抗生素抑制和/或庆大霉素膀胱冲洗。在扩大组中，有 35 例尿路感染，每例患者的感染发生率为 0.22 次/患者-年，而对照组为 32 例感染和 0.28 次/患者-年。没有因感染并发症而丢失移植物。
在我们的系列研究中，与对照组相比，接受膀胱扩大术的患者在肾移植后尿路感染率没有增加。这一发现可能归因于胃扩大术、抗反流再植术和庆大霉素冲洗的应用。
