Renal transplantation with and without bladder augmentation in children posterior urethral valve is there a difference in the long term?

PurposePosterior urethral valve (PUV) is a common etiology of end-stage renal disease(ESRD) in children. We compared children who underwent bladder augmentation prior to renal transplantation with those who underwent transplantation in the native bladder in regards to occurrence of UTI and long term renal function.Material and MethodsWe identified 40 patients with PUV from 1992 and 2006 who underwent renal transplantation in our institution. These patients were divided into two groups, Group 1: 20 patients who underwent bladder augmentation and Group 2 20 patients who did not undergo bladder augmentation. Graft dysfunction was defined as an increase of >20% in creatinine levels.ResultsForty-four transplantations were performed, 21 in G1 and 23 in G2, 35 from deceased donors(16 in G1 and 19 in G2). Medium age at transplantation was 11 years (5 to 17). Bladder drainage was done using clean intermittent catheterization by external continent ostomy in 95% of patients. Average renal graft survival at one year was 88% for both groups, after 5 years values were maintained of 90% in G1 and 87% in G2. Acute rejection occurred in 15% of grafts in G1 and 26% in G2. Urinary tract infection (UTI) was found in 85% of G1 and 25% of G2. An increase in creatinine of 20% above the nadir was found in 33% of G1 patients and 10% in G2.ConclusionsPatients who underwent bladder augmentation had a higher incidence of infection and increase of creatinine levels, however these events did not affect renal graft survival when compared to non-augmented patients.