Renal transplantation in patients with lower urinary tract dysfunction.

Between June 1980 and December 2001, 1076 kidney transplantations were performed in our department, including 29 transplantations on 27 patients with lower urinary tract pathology (Table 1). The average age of the recipients was 29 years (range 13 to 51) and the male:female patient ratio was 23:4. The etiology of the abnormal lower urinary tract was neurogenic bladder in 10 patients (meningomyelocele in 6, spine trauma in 3, and diabetes in 1), posterior urethral valves in 9, bladder neck obstruction in 3, previous cystectomy in 4 (severe pelvic trauma in 2 cases, acute hemorrhagic cystitis and tuberculosis in 1), and bladder contraction after tuberculos in 1. Pretransplantation evaluation included a medical interview, physical examination, urinalysis, urine culture, renal ultrasound, cystourethrography, and urodynamic studies. Augmentation cystoplasty had been previously performed in 4 (14.8%) cases; 5 (18.5%) patients had urinary drainage into an ileal conduit, and 6 (22.2%) patients, a cutaneous ureterostomy. The remaining 12 (44.5%) patients underwent transplantation into a native bladder. Three patients (10.3%) received kidneys from living related donors. The graft was inserted in the right iliac fossa using an extraperitoneal approach in all cases.