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21 May 2009

Lower urinary tract reconstruction in a kidney transplant patient with neurogenic bladder

I Bałasz-Chmielewska, I Zagożdżon, M Drożyńska-Duklas, L Komasara, A Gołębiewski, P Czauderna, A Żurowska

Ann Transplant 2009; 14(1): 59-60 :: ID: 880415


Background: Patients with neurogenic bladder who are qualified for kidney
transplantation require a thorough preparation of urinary tract for a correct
outflow of urine from the transplanted kidney. Preferably, reconstruction
procedures should be performed prior to transplantation.
Material/Methods: This report presents a case of a 25-year old patient with
neurogenic bladder due to myelomeningocele (MMC), who underwent kidney transplantation in February 2004. The procedure was preceded by a 3-year long period of anuria. Prior to transplantation bladder volume was decreased (220 ml) and the detLPP (detrusor leak point pressure) increased (>40 cm H[sub]2[/sub]0) without signs of vesicoureteral reflux. During the first two years after transplantation the patient experienced numerous episodes of urinary tract infections (UTI), including five episodes of acute pyelonephritis in transplanted kidney. The LPP increased to 70 cm H[sub]2[/sub]0, voiding cystourethrography revealed a significant vesicoureteral reflux to the transplanted kidney, and creatinine levels rose from 0.9 to 1.6 mg/dl. In order to protect further graft deterioration a cystoplasty was performed with a Meinz-Pouch procedure followed by Mitrofanoff appendicovesicostomy in November 2006.
Results: A marked decrease in the frequency of UTI and improvement of graft function has been observed.
Conclusions: Although in patients with neurogenic bladder the optimal time for reconstruction procedures is before kidney transplantation, it can also be performed after grafting.

Keywords: Kidney Transplantation, case report, clinical outcome

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358