Login to Access Video or Poster Abstract: MP74-20
Sources of Funding: none

Introduction

Renal transplantation in patients with lower urinary tract (LUT) dysfunction is a unique challenge, as they are at higher risk of urinary tract infection, sepsis, surgical complications, allograft dysfunction and graft loss. We opt to identify the impact of pre-transplant bladder cycling on the urological complications, graft function and lower urinary tract function

Methods

The study included patients maintained on hemodialysis for more than 12 months with oliguria or anuria, reduced bladder capacity by ascending cystogram, poor compliance by cystometry, no history of lower urinary tract dysfunction and have no evidence of urological cause of renal failure. Patients were randomly allocated into two groups, group I received direct renal transplantation without bladder recycling. Group II received renal transplant after programmed bladder recycling through bladder instillation of sterile water in amount equal to the estimated bladder capacity to be gradually increased till patient can withstand filling the bladder with 200 cc for 2 hours. Standard renal transplantation was carried out with stented Leich Gregoir ureteroneocystostomy. Urological complications and graft functions were recorded at 3 months. Patients were assessed by IPSS, Cystogram as well as cystometry. To achieve a difference in mean cystometric capacity of 50 cc in favor of bladder training patients, 16 patients in each group are required to achieve a power of 80% and an ? error of 0.05.

Results

A total of 22 patients were randomized so far including 11 patients in each group. All the cases underwent right iliac renal allotransplantation. Urinary leakage occurred in 2 cases (18%) in group I that was managed conservatively and subsided with prolongation of the internal stent and one case required percutaneous tube drainage. In group II urinary leakage occurred in one case (9%) that was managed by surgical exploration and redo ureterovesical reimplantation (p= 0.07 ). At 3 months, mean serum creatinine was 0.9 mg/dl and 1 mg/dl in both groups respectively (p= 0.4 ). Symptom score was 9 and 11 in both groups respectively (p =0.09 ). Mean cystometric capacity three months after transplant was 382 cc and 397 cc in both groups respectively (p= 0.1)

Conclusions

Pretransplant programmed bladder recycling for patients with defunctionalized bladder provide no clinical advantage as regard postoperative urological complications, graft function, lower urinary tract symptoms and cystometric capacity.

Funding

none