多中心评估肾移植中复杂尿流改道：复杂手术解决方案的结果。

Multicenter evaluation of complex urinary diversion for renal transplantation: outcomes of complex surgical solutions.

机构信息

Department of Urology, Philipps-University Marburg, Baldinger Street, 35043, Marburg, Germany.

Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

出版信息

World J Urol. 2024 Apr 17;42(1):239. doi: 10.1007/s00345-024-04934-1.

DOI:10.1007/s00345-024-04934-1

PMID:38630278

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11023965/

Abstract

PURPOSE

An abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult.

METHODS

The indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up.

RESULTS

Of 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4).

CONCLUSION

The mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary.

摘要

目的

下尿路异常给移植外科医生带来了巨大挑战。除了将输尿管吻合到回肠导管，还有多种复杂的重建解决方案。由于其罕见性，复杂尿流改道的标准化和教学极其困难。

方法

在 8 个泌尿科移植中心回顾性研究了肾移植（KT）后复杂尿流改道的适应证和结果，包括当前的随访。

结果

37 例患者中有 21 例（56%）为男性，其中最常见的终末期肾衰竭病因是：输尿管反流（24%）、脊柱裂（22%）和肾小球肾炎（12%）。在 30 例（81%）患者中，在 KT 之前进行了尿流改道，中位时间为 107.5（范围，10；545）个月前。中位患者年龄为 43（10；68）岁，包括 6 例（16%）活体供者。在 12 次（32%）移植手术中对尿流进行了修改。在 KT 后，25 例（67%）患者中最常见的是不可控的回肠造口术；3 例患者分别使用 Mainz 袋 I 和膀胱扩大术作为最常见的可控性尿流改道。中位随访时间为 120 个月（范围 0；444），12 例（32%）患者出现移植物失功，5 年移植物存活率为 79%（95%CI 61；90）。中位总生存率为 227 个月（168；286），5 年总生存率为 89%（69.3；96.4）。