Utility of Pre-Transplant Bladder Cycling for Patients With a Defunctionalized Bladder. A Randomized Controlled Trial

Abstract

To study the necessity of pre-transplant programmed bladder cycling (PBC) in patients with defunctionalized bladder (DB). This RCT included renal transplant (RT) candidates with DB. Eligible patients were assigned to two groups, group I underwent PBC before RT and group II underwent direct RT into the DB. The primary outcome was to assess the efficacy of PBC in improving post- RT bladder capacity. Secondly, to compare its impact on early urological complications and 3-month voiding function and 1-year graft function and survival. Graft function was evaluated using serum creatinine and eGFR using MDRD equation. Groups I included 23 patients and group II included 20 patients. The mean ±SD of bladder capacity was 88.7±11.7ml and 90.6 ±9.8ml in both groups, respectively (P= 0.5). In group I, PBC increased bladder capacity to 194.7 ±21.2 ml (P<0.001). Targeted bladder capacity was achieved in 19 (82.6 %) patients and two patients developed UTI. At 3-months, bladder capacity, compliance and bladder contractility index improved significantly in both groups with a significant reduction in maximum detrusor pressure with no significant difference between both groups (P= 0.3,0.4, 0.2 and 0.8, respectively). Urinary leakage occurred in one (4.3%) and three patients (15%) in group 1 and 2, respectively (P=0.2). At 1-year, no statistically significant differences in the median (IQR) serum creatinine (P= 0.05) and eGFR (P= 0.07) between both groups were noted. Pre-transplant PBC for DB-patients provided no clinical advantage concerning postoperative urological complication, urodynamic criteria and graft function and survival.