MacGregor P, Novick A C, Cunningham R, Streem S, Kay R, Steinmuller D, Buszta C, Steinhilber D
J Urol. 1986 Apr;135(4):686-8. doi: 10.1016/s0022-5347(17)45819-8.
From 1971 to 1984 renal transplantation was performed in 20 patients with end stage renal disease who presented with an existing form of urinary diversion. These patients were evaluated with a cystometrogram, voiding cystourethrogram and cystoscopy. In some cases bladder function was studied further by cycling through a suprapubically placed catheter. The bladder was considered unstable in 13 patients and undiversion was done at transplantation. The period of prior diversion ranged from 3 to 20 years (mean 12.7 years). There were no surgical complications postoperatively and normal bladder function returned in all patients. Currently, 8 patients have a functioning renal allograft 16 months to 9 years after transplantation (mean 4.2 years). Seven patients were considered to have a nonusable bladder owing to severe neurogenic disease or refractory contracture. In these patients transplantation was done into a pre-fashioned intestinal conduit (5) or cutaneous ureterostomy (2). Currently, 4 patients have a functioning renal allograft 16 months to 6.2 years after transplantation (mean 3.8 years). Transplantation candidates who present with an existing form of urinary diversion should be evaluated carefully, since many will have a usable bladder. Regardless of whether the bladder is usable, transplantation can be performed safely with no increased surgical or immunological risk.
1971年至1984年期间，对20例终末期肾病且已存在尿流改道形式的患者进行了肾移植。这些患者接受了膀胱测压、排尿性膀胱尿道造影和膀胱镜检查。在某些情况下，通过经耻骨上放置的导管进行周期性操作进一步研究膀胱功能。13例患者的膀胱被认为不稳定，在移植时进行了去转流手术。先前转流的时间为3至20年（平均12.7年）。术后无手术并发症，所有患者膀胱功能均恢复正常。目前，8例患者在移植后16个月至9年（平均4.2年）拥有功能良好的同种异体肾移植。7例患者因严重神经源性疾病或难治性挛缩被认为膀胱无法使用。在这些患者中，移植到预先制作的肠道导管（5例）或皮肤输尿管造口术（2例）中。目前，4例患者在移植后16个月至6.2年（平均3.8年）拥有功能良好的同种异体肾移植。对于已存在尿流改道形式的肾移植候选者应进行仔细评估，因为许多患者将有可用的膀胱。无论膀胱是否可用，均可安全进行移植，且手术或免疫风险不会增加。
