TOTAL ANATOMIC URINARY-TRACT REPLACEMENT AND RENAL-TRANSPLANTATION - A SURGICAL STRATEGY TO CORRECT SEVERE GENITOURINARY ANOMALIES

During renal transplantation, the donor ureter is normally anastomosed to the recipient bladder, However, preexisting anomalies of the lower urinary tract or previous surgical interventions may render the recip ient bladder unusable. Although in such situations urine may be extern alized via cutaneous ureterostomy or an ileal conduit, both techniques are frequently complicated by bacterial colonization or chronic infec tion. To overcome these problems, the authors have been treating such children via extensive, staged, bladder reconstruction (augmentation) before transplantation. On rare occasions, however, the absence of a u sable bladder necessitates the creation of a complete neobladder from other visceral tissues. The authors present two cases in which patient s underwent complete anatomic reconstruction of the lower urinary trac t before renal transplantation. This approach results in the optimal e nvironment for allograft function and leads to a greater rehabilitatio n than that achieved with urinary diversion. Copyright (C) 1998 by W.B . Saunders Company.