Role of the bladder in delayed failure of kidney transplants in boys with posterior urethral valves

Purpose: There is a tendency toward less favorable long-term graft function in patients with posterior urethral valves than in controls. me studied th e role of the bladder in boys who underwent transplantation by simultaneous ly evaluating renal graft and voiding function. Materials and Methods: Between 1972 and 1994, 66 boys with posterior urethr al valves underwent kidney transplantation. Of these boys 44 with a mean ag e of 4.7 years who retained a functional renal graft did not undergo any su rgery on the lower urinary tract except for the initial treatment of poster ior urethral valves. Long-term evaluation included a voiding questionnaire, radiological assessment and serum creatinine measurement. Results: Average followup was 9.01 years (range 2.4 to 19.6). There was no voiding dysfunction symptomatology in 23 boys, while 3 (14.2%) and 8 (38.1% ) of the remaining 21 had daytime and nighttime frequency, respectively, Dy suria and incontinence were present in 11 (52.4%) and 12 (57.1%) patients, respectively. Urodynamics in 11 cases revealed a mean bladder compliance pl us or minus standard deviation of 11.3 +/- 2.8 ml./cm. water. In boys with a voiding disorder mean serum creatinine increased after 5 years of followu p. At 10 years after kidney transplantation mean serum creatinine was 140.3 +/- 36.0 and 285.7 +/- 36.2 mu mol./l. in asymptomatic boys and those with a voiding disorder, respectively (p <0.01). Conclusions: Valve bladder has a role in the deterioration of renal transpl ants in boys with posterior urethral valves. in those with a voiding disord er closer followup is needed, including urodynamic and radiological studies . Bladder dysfunction, such as hypocompliance and/or hyperreflexia, require s medical or surgical treatment.