Yamazaki Y, Tanabe K, Ota T, Ito K, Toma H
Department of Urology, Tokyo Women's Medical College, Japan.
Int J Urol. 1998 Sep;5(5):423-7. doi: 10.1111/j.1442-2042.1998.tb00381.x.
Urinary bladder augmentation is gaining popularity for the treatment of dysfunctional bladders in renal transplant patients. Although reported cases of adult and pediatric transplants into the augmented bladder have been favorable, the potential risk of urinary tract infection and graft failure under immunosuppression is still disputable. We report our experiences with 4 patients who underwent renal transplantation into an augmented bladder.
Between 1971 and 1996, 1275 renal transplants were performed at our institution. Of these transplants, 4 patients underwent renal transplantation into an augmented urinary bladder. Augmentation cystoplasty was performed before transplantation in 3 patients and 7 years after transplantation in the other patient. The bladder was augmented with an ileal segment in 3 patients and a ureter in the fourth patient. Graft function was assessed by the serum creatinine level. Fluorocystometrograms were performed in all patients at fixed intervals.
Posttransplant renal function was satisfactory overall and no patient exhibited proteinuria. All patients except 1 acquired a large capacity low pressure bladder and remained continent with clean intermittent catheterization. One patient who underwent ureterocystoplasty is still incontinent because of his relatively small bladder capacity. Posttransplant pyelonephritis was documented in 3 patients during the follow-up period, but no other complications were observed.
Our study demonstrates that renal transplantation into extensively reconstructed bladders can be safely performed with good success. Although urinary tract infection is a major consideration, we recommend pretransplant reconstruction not only to preserve graft function, but also to achieve urinary continence.
膀胱扩大术在治疗肾移植患者膀胱功能障碍方面越来越受欢迎。尽管已有报道称成人和儿童肾移植到扩大膀胱中的病例效果良好，但免疫抑制状态下尿路感染和移植失败的潜在风险仍存在争议。我们报告了4例接受肾移植到扩大膀胱中的患者的经验。
1971年至1996年间，我们机构共进行了1275例肾移植。其中，4例患者接受了肾移植到扩大膀胱中。3例患者在移植前进行了膀胱扩大术，另1例患者在移植后7年进行。3例患者用回肠段扩大膀胱，第4例患者用输尿管扩大膀胱。通过血清肌酐水平评估移植肾功能。所有患者定期进行膀胱测压造影。
移植后肾功能总体令人满意，无患者出现蛋白尿。除1例患者外，所有患者均获得了大容量低压膀胱，并通过清洁间歇性导尿保持了控尿。1例接受输尿管膀胱成形术的患者因膀胱容量相对较小仍存在尿失禁。随访期间3例患者记录有移植后肾盂肾炎，但未观察到其他并发症。
我们的研究表明，肾移植到广泛重建的膀胱中可以安全地进行，并且成功率很高。尽管尿路感染是一个主要考虑因素，但我们建议移植前进行重建，不仅是为了保留移植肾功能，也是为了实现尿失禁。
