Salman Baher, Hassan Ahmed, Sultan Sultan, Tophill Paul, Halawa Ahmed
From the Urology Department, Menofia University Hospitals, Egypt.
Exp Clin Transplant. 2018 Feb;16(1):10-15. doi: 10.6002/ect.2016.0193. Epub 2017 Jul 31.
Normal urinary bladder stores urine at low pressure, does not leak, and completely empties by natural voiding. An abnormal bladder may be due to neurologic or urologic disorders that render the bladder of small capacity, of high storage pressure, or of poor compliance. The aim of this study was to determine the long-term outcomes of renal transplant in patients with abnormal bladders.
We retrospectively compared 30 transplanted kidneys in 25 patients with abnormal bladders with a control group comprising 30 grafts transplanted simultaneously during the same period of time (1990-2014) in 30 patients without bladder abnormality. Patient demographics, graft function, survival, and postoperative complications were compared.
Patients with abnormal bladders received transplants at a younger age than the control group (32 ± 17 vs 47 ± 12 y; P <. 001). Graft survival was not significantly different between the study and the control groups at 1 (90% vs 97%; P = .30), 3 (88% vs 91%; P = .67), and 5 years (82% vs 87%; P = .68). On long-term follow-up (20 years), 19 grafts (63%) were functioning in the study group compared with 25 grafts (83%) in the control group, suggesting inferior survival in those with an abnormal bladder after the first 10 years of transplant. In the abnormal bladder group, there was higher incidence of urologic complications (93% vs 50%; P<.001).
Despite the earlier age at transplant, the previous urologic operations, and the high incidence of urinary tract infection after renal transplant, graft survival and functions after renal transplant were not significantly different between patients with abnormal and normal bladders over at least the first 10 years. Therefore, it is safe to transplant into abnormal bladders once they have been assessed, reconstructed if necessary, and managed appropriately.
正常膀胱能在低压下储存尿液，不会漏尿，并能通过自然排尿完全排空。异常膀胱可能是由于神经或泌尿系统疾病导致膀胱容量小、储存压力高或顺应性差。本研究的目的是确定膀胱异常患者肾移植的长期结果。
我们回顾性比较了25例膀胱异常患者的30个移植肾与同期（1990 - 2014年）30例无膀胱异常患者同时移植的30个移植物组成的对照组。比较了患者的人口统计学特征、移植物功能、存活率和术后并发症。
膀胱异常患者接受移植的年龄比对照组年轻（32±17岁对47±12岁；P<.001）。研究组和对照组在1年（90%对97%；P =.30）、3年（88%对91%；P =.67）和5年（82%对87%；P =.68）时移植物存活率无显著差异。长期随访（20年）时，研究组有19个移植物（63%）仍在发挥功能，而对照组有25个移植物（83%），这表明移植后前10年膀胱异常患者的移植物存活率较低。在膀胱异常组，泌尿系统并发症的发生率较高（93%对50%；P<.001）。
尽管膀胱异常患者移植时年龄较小、既往有泌尿外科手术史且肾移植后尿路感染发生率较高，但至少在最初10年，膀胱异常和正常患者肾移植后的移植物存活率和功能无显著差异。因此，一旦对异常膀胱进行评估、必要时进行重建并适当管理，将肾移植到异常膀胱中是安全的。
