Continent urinary diversion in preparation for renal transplantation a - Staged approach

Background. We prospectively assessed the safety of kidney transplantation into continent urinary intestinal reservoirs as a planned two-stage procedu re in patients with absent or dysfunctional lower urinary tract. Methods. Between November 1990 and June 1999, 12 patients have undergone re nal transplantation into continent urinary reservoirs, and a further patien t with a diversion is awaiting transplantation. This was part of a larger s eries of 356 patients who had undergone continent diversions during that pe riod. A further 174 patients (33%) had diversions into ileal conduits. Findings. Within a mean follow-up of 26.1 months (5-72) after transplantati on renal function was stable with serum creatinine values ranging from 0.9 to 1.8 mg/dl, There were 5 reoperations in the 12 patients (40%), Two patie nts needed their continence mechanism replaced, One had renal vein thrombos is with loss of the transplant, The cause for this was unknown but it had b een speculated that it could have been caused by graft/body size disproport ion. A second kidney was successfully transplanted after 12 months; Two fur ther revisions were required for ureteric kinking and lymphocele. The patie nt with orthcatopic substitution voids to completion. The other patients ar e continent day and night with easy catheterization. Interpretation. This is one of the largest single series reported to date o f renal transplantation into continent urinary diversions, and we commend t he ap proach in carefully selected patients, but the difficulties must not be underestimated and the specific problems of intestinal urinary reservoir s have to be reckoned with. These procedures should be confined to centers with considerable experience with this type of surgery and its complication s, Lifelong close surveillance is critical for the success of this concept.