目的:下尿路异常对移植外科医生构成重大挑战。除了输尿管吻合到回肠导管,有各种各样复杂的重建解决方案。由于它的稀有性,复杂尿流改道的标准化和教学难度极大。
方法:在8个泌尿外科移植中心对肾移植(KT)后复杂的尿路改道的适应症和结果进行了回顾性调查,包括目前的随访。
结果:在37例患者中,21例(56%)男性,膀胱输尿管反流(24%),脊柱裂(22%),肾小球肾炎(12%)是终末期肾衰竭的最常见原因。在30名(81%)患者中,在KT之前进行尿流改道,中位数为107.5(范围,10;545)个月前。进行移植的患者年龄中位数为43(10;68)岁,包括六份(16%)生活捐款。在12次(32%)移植期间,尿液改道得到了改善。KT之后,回肠导管是25例(67%)患者中最常见的尿失禁尿路改道;Mainz袋I和膀胱增大是最常见的尿路改道(每组n=3).在120个月的中位随访时间(范围0;444),12例(32%)患者移植失败,5年移植物存活率为79%(95CI61;90)。中位总生存期为227个月(168;286),5年总生存期为89%(69.3;96.4)。
结论:复杂尿流改道的中期肾移植功能似乎与常规尿流改道的移植相当。因此,复杂的尿流改道应始终被视为一种手术选择,即使在移植过程中,如有必要。
OBJECTIVE: An abnormal lower urinary tract poses significant challenges for transplant surgeons. Besides the ureteral anastomosis to an ileal conduit, there are diverse complex reconstructive solutions. Due to its rarity, standardization and teaching of complex urinary diversion is extremely difficult.
METHODS: The indications and outcomes of complex urinary diversions after kidney transplantation (KT) were retrospectively investigated at eight urologic transplant centers including a current follow-up.
RESULTS: Of 37 patients with 21 (56%) males, vesicoureteral reflux (24%), spina bifida (22%), and glomerulonephritis (12%) were the most common causes of terminal renal failure. In 30 (81%) patients, urinary diversion was performed before KT, at a median of 107.5 (range, 10; 545) months before. Transplantations were held at a median patient age of 43 (10; 68) years, including six (16%) living donations. Urinary diversion was modified during 12 (32%) transplantations. After KT, the ileal conduit was the most common incontinent urinary diversion in 25 (67%) patients; a Mainz pouch I and bladder augmentation were the most frequent continent diversions (each n = 3). At a median follow-up of 120 months (range 0; 444), 12 (32%) patients had a graft failure with a 5-year graft survival of 79% (95%CI 61; 90). The median overall survival was 227 months (168; 286) and the 5-year overall survival 89% (69.3; 96.4).
CONCLUSIONS: The mid-term kidney transplant function with complex urinary diversion appears to be comparable to transplants with regular urinary diversions. Hence, complex urinary diversion should always be considered as a surgical option, even during transplantation, if necessary.