Bladder Augmentation and Urinary Diversions in Kidney Transplants

Abstract

There is some controversy about the safety of kidney transplant in patients with augmented or diverted urinary system: they are considered higher risk recipients in view of increased technical problems and infective complications leading to pyelonephritis and graft loss. The ureter of a transplanted kidney should be anastomosed into a reservoir with an adequate capacity, with low bladder pressure, with good compliance, and efficient voluntary empting. Ileal and sigmoid bladder augmentation, usually associated with clean intermittent catheterization, has become a well-accepted part of the urological practice and has been used for implantation of the transplant ureter. During the last years, the interest in new biomaterials for reconstructive surgery has increased. Experimental studies showed how these requests can be satisfied by porcine small intestinal submucosa SIS (Stratasis”): this can be degraded by the host and substituted by “new tissue”. In four recent cases we have used SIS to obtain an augmented, normal-pressure and good compliance bladder reservoir, with three (epithelial, muscular and adventitial) layers normally represented.