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Titolo:
A new, unique and simple method for ureteral implantation in kidney recipients with small, defunctionalized bladders
Autore:
Salvatierra, O; Sarwal, M; Alexander, S; Lemley, KV; Yorgin, P; Al-Uzri, A; Lu, A; Millan, M; Alfrey, E;
Indirizzi:
Stanford Univ, Sch Med, Dept Surg, Stanford, CA 94305 USA Stanford Univ Stanford CA USA 94305 ed, Dept Surg, Stanford, CA 94305 USA Stanford Univ, Sch Med, Dept Pediat, Stanford, CA 94305 USA Stanford UnivStanford CA USA 94305 , Dept Pediat, Stanford, CA 94305 USA
Titolo Testata:
TRANSPLANTATION
fascicolo: 6, volume: 68, anno: 1999,
pagine: 731 - 738
SICI:
0041-1337(19990927)68:6<731:ANUASM>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
RENAL-TRANSPLANTATION; AUGMENTATION CYSTOPLASTY; RECONSTRUCTION; ENTEROCYSTOPLASTY; CHILDREN; RUPTURE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Salvatierra, O Stanford Univ, Med Ctr, 703 Welch Rd,Suite H-2, Palo Alto, CA 94304 USA Stanford Univ 703 Welch Rd,Suite H-2 Palo Alto CA USA 94304
Citazione:
O. Salvatierra et al., "A new, unique and simple method for ureteral implantation in kidney recipients with small, defunctionalized bladders", TRANSPLANT, 68(6), 1999, pp. 731-738

Abstract

Background Major, almost insurmountable, deterrents exist to the use of the small capacity, defunctionalized, nonneurogenic urinary bladder in renal transplantation, namely, the technical difficulty in performing a satisfactory ureteral implantation with conventional methods and the potential secondary problems with high grade ureteral reflux and obstruction. Alternativesare less than ideal and include transplantation into a bowel-augmented urinary bladder with intermittent self-catheterization, ileal conduit urinary diversion, or avoidance of transplantation and relegating the patient to life-long dialysis. Methods. Eight consecutive patients (ages 13 months to 29 years) with small, defunctionalized urinary bladders underwent a new method of intravesicalimplantation of the transplant ureter. The mean capacity of these bladderswas 18.5+/-13.1 ml (range 6 to 45 mi), with the bladders defunctionalized for a mean 81.6+/-24.3% of the patients' total lifetime. The technique involved placement of the transplant ureter into a shallow, mucosa-denuded, rectangular trough extending from a superiorly placed ureteral hiatus distallyto the trigone. We hypothesized that the mucosal margins on the two lateral aspects of the rectangular trough would grow over the anterior surface ofthe meter until they met the advancing mucosal edges from the contralateral side to form a natural neosubmucosal tunnel. Results. Posttransplantation cystoscopic examination demonstrated bladder mucosal regeneration and growth over the ureter, confirming the spontaneousdevelopment of a good length neosubmucosal tunnel. All patients demonstrated no evidence of ureteral reflux or ureteral obstruction, whereas an immediate prior cohort of four consecutive patients with bladder capacities lessthan or equal to 30 mi showed that three of four had ureteral reflux (P=0.02) and four of four developed hydronephrosis (P=0.002). All urinary bladders in the present cohort enlarged to expected normal or near-normal capacities. Serum creatinines were stable throughout the entire follow-up period, with the exception of one patient who had rejection episodes. Two patients had urinary tract infections posttransplantation, but there were no episodes of acute pyelonephritis. Conclusions. This novel technique for ureteral implantation successfully capitalizes on the regenerative potential of the bladder mucosa, resulting in a physiological, anatomically natural, and very effective neosubmucosal tunnel. It appears to guarantee success against both ureteral reflux and obstruction, no matter how small the urinary bladder, and offers no hindrance to enlarging the bladder to near normal capacity posttransplantation. The implantation technique is simple and safe, and its use should eliminate the reluctance to use these bladders. Moreover, this procedure offers a major incentive for the successful rehabilitation of small, defunctionalized, nonneurogenic bladders after kidney transplantation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 03:42:40