Factors Predicting Renal Function Outcome after Augmentation Cystoplasty

We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was7.0±2.6years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median114±53.6to342.1±68.3 ml (p=.0001),68.5±19.9to28.2±6.9 cm H2O (p=.0001), and3.0±2.1to12.8±3.9(p=.0001), respectively. Renal function remained stable and improved in 22 (76%) patients from median eGFR135±81.98to142.82±94.4 ml/min/1.73 m2(p=.160). Significant deterioration was found in 7 (24%) patients from median eGFR68.25±42to36.57±35.33(p=.001). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87,p=0.0155) and noncompliance (OR 30.78,p=0.0156) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency.

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Response to “Reduction of cystometric bladder capacity and bladder compliance with time in patients with end-stage renal disease”

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2012.07.025 ◽

2013 ◽

Vol 112 (2) ◽

pp. 110

Author(s):

Chung-You Tsai ◽

Shiu-Dong Chung

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Bladder Capacity ◽

Bladder Compliance ◽

Stage Renal Disease ◽

End Stage

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Impact of surgical intervention on progression to end-stage renal disease in patients with posterior urethral valve

African Journal of Urology ◽

10.1186/s12301-021-00261-8 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Rishikesh Velhal ◽

Aadhar Jain ◽

Anveshi Nayan ◽

Sujata Patwardhan ◽

Bhushan Patil

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Posterior Urethral Valve ◽

Renal Outcome ◽

Lower Urinary Tract Obstruction ◽

Significant Difference ◽

Febrile Uti ◽

Urethral Valve ◽

Stage Renal Disease ◽

End Stage

Abstract Background Posterior urethral valve patients present with varied presentations at any age of life and have significant associated morbidity and require long-term follow-up and care. Methods This was a single-center ambispective cohort study carried out over a period of 2 years. Patient data regarding the symptoms, investigations, interventions, secondary complications were recorded and were followed up regularly during the study till either normalization of their creatinine level which was maintained up to one-year post-fulguration (non-CKD) or progression to end-stage renal disease (ESRD) requiring renal transplant. Various clinical factors were then compared between these groups. Results The age of presentation varies from 6 months antenatal period to a maximum of 34 years. Most common symptom was of lower urinary tract obstruction, followed by recurrent febrile UTI. The interval between disease presentation detection and PU valve fulguration ranged from 6 days to more than 5 years, median duration being 1 month. 85.7% patients had hydroureteronephrosis on initial USG. In VCUG, there was no significant difference found between the presence of reflux and poor renal outcome. Age of presentation greater than 2 years was seen in 52% of patients with CKD compared to only 10% patients in non-CKD group (significant, p value 0.02). Among patients who developed CKD, 60% of patients had PU valve fulguration after one month of disease presentation, while in contrast, among the non-CKD group, 80% of patients had it done within one month of disease presentation. (significant, p value 0.03). Conclusions Late age of presentation, delayed fulguration with high initial creatinine, and failure of serum creatinine to return to normal after one-month post-fulguration are important risk factors in the progression of the disease to ESRD. Symptomatic improvement after interventions does not correlate with progression to ESRD. The number of interventions also does not predict progression to ESRD. Interventions should be chosen wisely on case to restore near-normal physiology and delay progression to ESRD.

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Safety of augmentation cystoplasty in patients with bladder abnormalities undergoing renal transplantation: a systematic review

Medical Journal of Indonesia ◽

10.13181/mji.oa.204358 ◽

2021 ◽

Vol 30 (3) ◽

pp. 198-206

Author(s):

Bobby Sutojo ◽

Gampo Alam Irdam

Keyword(s):

Renal Transplantation ◽

Bladder Capacity ◽

Cochrane Library ◽

Augmentation Cystoplasty ◽

Online Databases ◽

Allograft Function ◽

Bladder Abnormalities ◽

Stage Renal Disease ◽

End Stage ◽

Bladder Condition

BACKGROUND Augmentation cystoplasty (AC) has been recently proposed to improve a bladder condition before or after a renal transplantation for an optimal allograft function. Until now, AC in adults with end-stage renal disease (ESRD) is uncommon and rarely practiced. This study aimed to investigate the safety of AC in patients with bladder abnormalities who required renal transplantation. METHODS Studies of patients with ESRD and abnormal bladder who underwent AC were searched in ProQuest, PubMed, EBSCO, and Cochrane Library online databases. Only studies published in English from January 1985 to May 2020 were included. The keywords used were renal transplantation, bladder dysfunction, cystoplasty, and their synonyms. Data were extracted by two independent authors who selected, screened, and assessed the articles’ eligibility and quality. The outcomes were graft survival rate and complications of AC. RESULTS A total of 19 articles were included. AC improved an intravesical pressure, a bladder capacity, and a compliance in patients with ESRD and bladder abnormalities, allowing patients to undergo the renal transplantation. Even though AC in patients with renal transplantation resulted in a significantly higher urinary tract infection rate than patients who underwent renal transplantation only, performing AC after renal transplantation was considered safe. CONCLUSIONS AC was considered safe for patients with bladder abnormalities who underwent renal transplantation.

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