Comparison of Enterocystoplasty and Ureterocystoplasty before Kidney Transplantation

BACKGROUND Augmentation cystoplasty before or after renal transplantation is an option for patients with end-stage renal disease who are candidates for renal transplantation and have low capacity and poorly compliant bladders. OBJECTIVE To compare two surgical methods of bladder augmentation-enterocystoplasty (EC) and ureterocystoplasty (UC)-before kidney transplantation, and their outcome with that in kidney recipients who had normal bladder function. METHODS During a 20-year period (1988-2008), 1406 renal transplantation were performed in our center by our team. In 16 patients having a mean age of 18.8 years, EC (group A) and in 8 with mean age of 11.5 years, UC (group B) were performed before renal transplantation. These two groups were compared with a control group of 30 recipients with normal bladder (group C) with mean age of 15.6 years, for kidney function, graft and patient survival, and the frequency of urinary tract infection (UTI). RESULTS There was normal graft function in 11 of group A, 7 of group B, and 24 of group C patients, during a mean follow-up of 73.1 months. The mean±SD serum creatinine in follow-up was 1.72±0.31, 1.37±0.13 and 1.33±0.59 mg/dL in groups A, B and C, respectively. No statistically significant differences were observed among the 3 studied groups in terms of 1-, 5- and 10-year graft and patient survivals. Number of episodes of febrile UTI requiring hospitalization was 23, 6 and 2 in groups A, B and C, respectively. UTI and urosepsis were significantly more frequent in group A than groups B (p=0.025) and C (p=0.001); no significant difference was observed in the frequency between groups B and C (p=0.310). CONCLUSION Both EC and UC are equally recommended before renal transplantation for reconstruction of the lower urinary tract; use of each method should be individualized depending on specific conditions of recipient.