Kidney transplantation in patients with an abnormal lower urinary tract.

Several factors influence the decision about which type of urinary drainage is best for any given patient. In a patient who has undergone cystectomy, supravesical drainage is required. However, many patients with upper tract urinary diversion have bladders that can be rehabilitated to provide adequate urinary storage. In most patients who have not had a cystectomy, the bladder can be augmented with bowel to achieve a suitable capacity. The urethral resistance component of continence can be achieved using bladder neck reconstruction, periurethral injection, or artificial urinary sphincter. Intermittent catheterization may be required following lower tract reconstruction. When reconstruction is possible, the native bladder is usually the best option for kidney transplant drainage. In general, one should provide an effective, low-pressure means of urine drainage that the patient can manage. With improvements in surgical technique and with better immunosuppressive regimens, kidney transplantation can be performed safely in patients with abnormal lower urinary tracts. Using appropriate bladder rehabilitation or supravesical diversion can preserve and even improve a patient's life style.