Lower Urinary Tract Abnormalities Research Articles

Valoración urodinámica en el cáncer de próstata con incontinencia

Update on the urodynamic evaluation in patients with prostate cancer who have incontinence. To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out. The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment. The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients.

Kidney Transplantation in Children With Augmentation Cystoplasty

Treatment of children with end stage renal disease, especially those with significant bladder dysfunction, is difficult. A high pressure and low capacity bladder is a major risk factor for a transplanted kidney. Cystoplasty can protect the kidney allograft by reducing the intravesical pressure and creating an appropriate capacity. The aim of this study was to evaluate the outcome of kidney transplantation in children with and without prior cystoplasty. A total of 43 children with bladder dysfunction in urgent need of cystoplasty were enrolled in the study and were compared to a control group with regard to acute and chronic rejection rates, survival of the transplanted kidney, surgical complications and febrile urinary tract infection. The rates of febrile urinary tract infection and chronic rejection were significantly higher in patients with prior cystoplasty (p<0.001 and p=0.004, respectively). Also, graft loss was much more frequent in these patients (34.9% vs 20.9%), although this difference was not statistically significant. In patients with prior cystoplasty graft survival rates were 92%, 73%, 58% and 45% at postoperative years 1, 3, 5 and 7, respectively. In the control group these rates were 94%, 87%, 81% and 75%, respectively (p=0.007). Based on our findings, the survival rate of the kidney is significantly lower in children with prior cystoplasty, possibly due to the higher prevalence of chronic rejection and febrile urinary tract infection in this group.

Renal Transplantation in Children

Objective Renal transplantation is the preferred method for the treatment of children in end-stage renal disease (ESRD). In this retrospective study, we analyzed the results at our center. Patients and Methods Between November 1993 and June 2006, 86 children (50 boys and 36 girls) received organs from 50 living donors (LDTx) and 36 cadaveric donors (CDTx). Twenty children were <10 years. In addition to ESRD, some patients had one or more other high-risk factors, eg, abnormal lower urinary tract in 36 recipients (42%). The procedure was a preemptive transplantation in 28, and a retransplantation in 9 recipients. Induction immunosuppression used either antithymocyte globulin (43 cases) or anti-interleukin-2 receptor antibodies (20 cases). Results Patients were followed for 6 to 150 months. There were 24 surgical complications (28%), 26 acute rejection episodes (33%), and 17 of systemic bacterial or viral infections. Two recipients died at 1 and 21 months. The 14 grafts were lost at 1 day to 87 months. The 1- and 10-year actuarial survival rates were 99% and 98%, respectively, for the recipients, and 88% and 84%, respectively, for the grafts. The 10-year actuarial graft survival rates were 98% in LDTx and 64% in CDTx; 86% in recipients >10 years old and 75% in recipients <10 years old. Abnormal urinary tract, pretransplantation dialysis, and transplant number showed no effect on graft survival. All pediatric recipients with functioning grafts are fully rehabilitated. Conclusion Renal transplantation is the preferred method of treatment for children in ESRD. Higher graft survival rates were achieved in older children and following LDTx.

Occult neurovesical dysfunction with anorectal malformations

To evaluate for the occurrence of occult NVD in children with anorectal malformations (ARM) using urodynamic evaluation. This prospective study was carried out on children with ARM prior to and following definitive procedure. Urodynamic studies were performed on the Phoenix Griffon machine (Albyn Medical) using Phoenix plus software. Nineteen children in the age range of 3 months to 156 months (mean = 19.2) were included in this study. Among these 19 children 13 underwent re-evaluation after definitive surgery for ARM. There were 11(57.9%) males and 8(42.1%) females. Of the 19 children 14 (73.7%) were cases of high anorectal malformation (HARM) and 5 (26.3%) were cases of low anorectal malformation (LARM). Baseline evaluation done in 19 children revealed seven urodynamic patterns: Normal capacity, compliant without uninhibited contractions (UIC) (21.1%); Normal capacity, compliant with UIC (5.3%); Normal capacity, poorly compliant without UIC (5.3%); Normal capacity, poorly compliant with UIC (10.5%); small capacity, compliant with UIC (5.3%); Small capacity, poorly compliant with UIC (26.3%) and large capacity, complaint with UIC (26.3%). Thirteen patients were evaluated post operatively also and in only 23% (3 of 13) no change in urodynamic pattern were observed. In the remaining 76.9% (10 of 13) some changes in urodynamics pattern were observed. The deleterious changes observed were appearance of UIC in 30.8% (4 of 13), decrease in the bladder capacity in 23% (3 of 13) and decrease in bladder compliance in 15.4% (2 of 13). Only 9 of of the 19 patients had normal urodynamics pre-operatively and post-operatively 3 more patients worsened. Incidence of occult NVD is high in patients with ARM even in the absence of clinical and radiological evidence of vertebral or lower urinary tract abnormalities. Though there seems to be a high incidence of changes in the neurovesical functions of these patients following definitive corrective surgery for ARM only time will show whether this has any deleterious effect on the upper tracts.

The use of refluxing ureter in the creation of a Mitrofanoff channel in children undergoing bladder augmentation: is a formal reimplantation necessary?

To study the fate of a refluxing ureteral stump used as a Mitrofanoff channel (MC) for clean intermittent catheterization (CIC), without reimplantation in augmented bladders. Ten boys and seven girls, 1-14 years old (mean 6.5 years) seen in period 1998-2005, underwent creation of MC using refluxing or potentially refluxing ureters. Concomitant bladder augmentation (BA) was performed for various abnormalities of lower urinary tract, including exstrophy epispadias complex, neurogenic bladder cloaca and posterior urethral valve. The uretero-vesical junction was maintained intact during creation of the MC. Follow-up period ranged from 2-72 months (mean 32.5 months). Satisfactory CIC was possible in 14 children while in two children the stoma became obstructed due to non-usage. Urinary leak via the ureteric MC was seen in only one patient who partially responded to anticholinergic therapy and a shortened CIC interval but this needed to be formally closed subsequently. A refluxing ureter can be used in the creation of a MC without formal reimplantation in the majority of children undergoing BA.

Effect of spinal cord abnormalities on the function of the lower urinary tract in patients with anorectal abnormalities.

We evaluated the effect of spinal cord abnormalities on lower urinary tract function in patients with anorectal abnormalities. We examined 30 patients with anorectal anomalies mainly because of fecal or urinary incontinence. All patients underwent spinal magnetic resonance imaging and urodynamic investigation. Major lumbosacral abnormalities were detected in 57% of patients, including 13, 4 and 3 with a tethered cord, syringomyelia and caudal regression, respectively. Significant dysfunction of the lower urinary tract in 57% of the cases involved an overactive detrusor in 11, detrusor-sphincter dyssynergia in 4, distended bladder in 4 and lazy bladder in 1. When the spinal cord was normal, 54% of the patients had abnormal urodynamic findings but when the spinal cord was abnormal, 59% had abnormal urodynamics. When the bony spine was normal, 33% of the patients had an abnormal spinal cord but when the bony spine was abnormal, 69% had an abnormal spinal cord. Patients with anorectal abnormalities and fecal or urinary incontinence problems often have an abnormal spinal cord and abnormal urodynamic findings. However, the state of the spinal cord is not the only factor explaining lower urinary tract function. Thus, the possibility of lower urinary tract dysfunction should be considered in each patient with anorectal abnormalities. If the patient has symptoms or findings suggesting abnormal lower urinary tract function urodynamic evaluation should be performed.

Outcome of Renal Transplantation in Children With Low Urinary Tract Abnormality

Introduction Patients with end-stage renal disease and lower urinary tract abnormality are often considered high risk for renal transplantation. Methods and subjects To examine the degree of risk, we studied patients who received renal transplants between 1985 and 2003. Forty eight patients had congenital lower urinary tract anomalies and 168 patients comprised a control group without these anomalies. Results Mean age and distribution of sex were not significantly different between the case and the control group. Among patients with anomalies, 8% had delayed graft function; 75%, acute rejection; and 39.5%, chronic rejection. Among the controls 2.3% had delayed graft function; 59%, acute rejection; and 35%, chronic rejection. None of these differences was significant. Mean survival time was 6 years in affected patients and 7.3 years in the control group ( P = .7). Among patients with anomalies the rate of graft survival in the first year after transplantation was 90%; and those in the third, fifth, and seventh years, 76%, 65%, and 40%, respectively. For the controls, the graft survivals were 88% at 1 year; 73% at 3 years; 70% at 5 years; and 49% at 7 years after transplantation. Conclusion This study showed that a history of lower urinary tract anomalies had no effect on graft function. Graft survival was not different among these patients compared with patients free of these anomalies.

Is Bladder Cycling Useful in the Urodynamic Evaluation previous to Renal Transplantation?

Objectives: To evaluate the usefulness of bladder cycling (BC) in differentiating between urodynamic abnormalities due to reversible bladder dysfunction and those due to preexisting lower urinary tract (LUT) abnormalities, and to determine if BC increases the diagnostic yield of urodynamic investigations (UIs) in these patients. Methods: Eleven patients with oligoanuria (<300 ml/day) were evaluated with complete UIs. All cases showed low compliance (mean 6 ml/cm H₂O) and low cystometric capacity (mean 146 ml) and were placed in a BC program. The indications for UIs were LUT symptoms in 2 patients, LUT abnormalities (myelodysplasia or urethral valves) in 3 patients, or the appearance of an extremely small bladder on cystogram (6 patients). BC was performed through a hypogastric catheter in an outpatient setting. UIs were repeated afterwards. Results: After BC, 5 patients (45%) continued to have low compliance (<8 ml/cm H₂O) and 4 patients (36%) had normal UIs. In 2 cases (18%), a previously unrecognized obstruction was diagnosed. No patient with LUT symptoms or abnormalities had a normal UI after BC. Conversely, 4 of 6 patients in whom BC was indicated due to a small bladder on cystogram had normal UIs after BC. Conclusions: BC is useful in explaining whether high bladder pressure is due to dysfunction or to preexisting disorders, and thus indicating the proper surgery for correction. Suprapubic BC significantly increases bladder capacity thus increasing the diagnostic yield of the UI.

DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM: QUANTITATIVE EVALUATION OF INCONTINENCE SYMPTOMS IN PEDIATRIC POPULATION

Functional voiding problems in children are common. Although pathophysiology and presentation of this clinical entity are well described, there is not yet a generally accepted method of quantitative and standard evaluation of clinical symptoms, and there are few studies addressing the issue of symptom scoring in children. We investigated use of a symptom scoring system in children with functional voiding problems and the normal population, and validated it using a scientific tool. A symptom scoring system was designed empirically. The questionnaire was composed of items regarding daytime symptoms, nighttime symptoms, voiding habits, bowel habits and quality of life. There were 2 groups whose symptoms were evaluated using this scoring system. Group 1 consisted of 86 patients who were admitted to our clinic with various wetting and daytime voiding problems. Group 2 consisted of 265 controls with no urological complaints. Parents of all children were asked to fill out a questionnaire that included the symptom scoring system. Boys with lower urinary tract abnormalities, and patients with spina bifida occulta and neurogenic bladder were excluded from the study. Odds ratios of answers to each item in the questionnaire were used to define strength of the questions to differentiate patients from healthy controls. According to the value of odds ratios, questions were modified and a score for each question was given. Receiver operating characteristic plots were used to define detection cutoff or threshold score, and Youden's index was used to detect best reflecting optimal sensitivity and specificity. The total score was determined to range from 0 to 35, and items were modified to 13 questions and 1 quality of life question at the end of the study. Among the 86 patients in group 1 (female-to-male ratio 1.5:1) mean score was 18.56. Among the 265 controls in group 2 (female-to-male ratio 1.5:1) mean score was 2.88. Statistical analysis revealed that within a confidence interval of 96.2% patients with a score of 8.5 or greater had voiding abnormalities, with 90% sensitivity and 90% specificity. There were no statistically significant differences between the 2 genders and 2 age groups of 4 to 7 and 8 to 10 years. This statistically validated functional voiding problems symptom score may provide accurate, objective and scientific bases to grade the symptoms in comparative research, diagnosis, treatment and followup of patients with wetting and functional voiding disorders.

Surgical complications in live‐donor pediatric and adolescent renal transplantation: Study of risk factors

To report the surgical complications among our pediatric and adolescent renal transplants and to analyze the different factors that may influence the occurrence of such complications. A total of 250 pediatric and adolescent renal transplants were included in this study. Of these patients, there were 154 boys and 96 girls with a mean age of 15.4+/-3.7 yr (range 5-20 yr). All patients received their kidneys from living donors. Four patients underwent renal retransplantation. Surgical complications were reported and their incidence was correlated with several pretransplant, technical and post-transplant risk factors by both univariate and multivariate analyses. The impact of surgical complications on graft and patient survival was computed using the Kaplan-Meier technique. Among the 250 patients, 35 surgical complications were encountered in 33 patients. These complications included urinary leakage in 10 patients, ureteric stricture in 11 patients, complicated lymphocele in eight patients, hematoma necessitating surgical exploration in two patients, wound dehiscence in one patient, stone of the graft ureter in one patient and renal artery stenosis in two patients. The incidence of urological complications (ureteral stenosis, urinary leakage and stone disease) was 8.8% and vascular complications 0.8%. Small ureteric leakage (four patients) was treated by endourologic techniques, whereas leaks associated with ureteral necrosis required open revision. Endourologic treatment was attempted in early and mild cases of ureteric obstruction. In late and severe cases, surgery was performed. On univariate analysis, the factors that significantly affected the incidence of surgical complications were recipient's age, lower urinary tract abnormalities, the type of primary urinary recontinuity, the time to diuresis, and height and weight of the patients. On multivariate analysis, the type of primary urinary continuity was the only factor that sustained statistical significance. Neither patient nor graft survival was affected by the occurrence of surgical complications. Primary urinary continuity is the only risk factor that affects the incidence of surgical complications among pediatric and adolescent live donor renal transplants, with the extravesical technique of Lich-Gregoir providing the best results. Surgical complications in pediatric and adolescent renal transplantation can be minimized if basic principles of careful transplant techniques are used. Prompt identification and treatment of any complication is paramount to graft and patient survival.

Renal transplantation in children with abnormal lower urinary tract

Objective This retrospective study reports the outcomes as well as pre- and posttransplant urologic treatments of renal transplantation for children with an abnormal lower urinary tract (LUT). Methods Between March 1981 and December 2001, 195 children (≤18 years of age) received live-donor kidney transplants. The 15 recipients (14 boys and 1 girl, mean age 13.5 ± 3 years) who had lower urinary tract disorders included posterior urethral valves (PUV) with valve bladder ( n = 12) and neuropathic bladders secondary to meningomyelocele ( n = 3). These children were evaluated by voiding cystourethrogram, cystourethroscopy, and cystometry. The children with PUV were maintained on clean intermittent catheterization (CIC) and a detrusor relaxant at least 3 months before transplantation. Augmentation ileocystoplasty or continent cutaneous diversion were used in three patients. The graft and patient survivals as well as complications in this cohort was compared with a group of children with normal LUT, who underwent renal transplantation during the same period. Results One child died in the early posttransplant period due to rupture of the external iliac artery. Follow-up ranged from 6 months to 16 years (mean = 4.5 years). During the same period the graft and patient survival rates were comparable between the group of children with versus without abnormal LUT. Furthermore, mean serum creatinine and creatinine clearance values were also comparable. The group with an abnormal LUT showed a higher incidence of urinary fistula (3/14) and recurrent UTI and/or bacteremia (4/14). Conclusions Renal transplantation is feasible with good results for children with abnormal LUT. Pre- and posttransplant urologic management is critical for a successful outcome. However these children display a high incidence of urologic and infectious complications.

RENAL TRANSPLANTATION IN CHILDREN WITH ABNORMAL LOWER URINARY TRACT: INTRODUCTION OF A NEW CONCEPT.

P691 Aims: In this retrospective study, the outcome of renal transplantation in children with abnormal lower urinary tract (LUT) is reported. In addition, pre- and post-transplant urological treatments are stated. Methods: Between March 1981 and December 2001, 195 children (≤ 18 years of age) received live-donor kidney transplants. Out of these, 15 (14 males and 1 female, mean age 13.5 ± 3 years) had lower urinary tract disorders in the form of posterior urethral valve (PUV) with valve bladder (12) and neuropathic bladder secondary to meningomyelocele (3). These children were evaluated by voiding cystourethrogram, cystourethroscopy and cystometry. The children with PUV were run on clean intermittent catheterization (CIC) and a detrusor relaxant at least 3 months before transplantation. Augmentation ileocystoplasty and / or continent cutaneous diversion were used in 3 patients. The children were assessed for graft and patient survival and for complications compared to a group of children with normal LUT, who underwent renal transplantation during the same period. Results: One child died in the early posttransplant period due to rupture of external iliac artery. Followup ranged from 6 months to 16 years (mean = 4.5 years). Graft survival was comparable between the group of children with and without abnormal LUT, who underwent transplantation during the same period. Patient survival, mean serum creatinine and creatinine clearance were also comparable in both groups. The group with abnormal LUT showed a higher incidence of urinary fistula (3/14) and recurrent UTI and / or bacteremia (4/14). Otherwise both groups were comparable. Conclusions: Renal transplantation in children with abnormal LUT is feasible with good results. Pre-and post-transplant urologic management is critical for a successful outcome. A high incidence of urological and infectious complications should be anticipated and properly managed.

SURGICAL COMPLICATIONS IN LIVE-DONOR PEDIATRIC RENAL TRANSPLANTATION: STUDY OF RISK FACTORS

P690 Aims: To report the surgical complications among our pediatric renal transplants and to analyze the different factors that may influence the occurrence of such complications. Methods: A total, 250 pediatric renal transplants were included into this study. Of these children there were 154 boys and 96 girls with a mean age of 15.4 ± 3.7 years (range 5 to 20). All patients received their kidneys from living donors. Four patients underwent repeat renal transplantation. Surgical complications were reported and their incidence was correlated with several pre-transplant, technical and post-transplant risk factors by both univariate and multivariate analyses. The impact of surgical complications on graft and patient survival was computed using the Kaplan-Meier technique. Results: Among the 250 patients, 35 surgical complications were encountered in 33 patients. These complications included urinary leakage in 10 patients, ureteric stricture in 11, complicated lymphocele in 8, hematoma necessitating surgical exploration in 2, wound dehiscence in 1, stone of the graft ureter in 1 and renal artery stenosis in 2. The incidence of urological complications (ureteral stenosis, urinary leakage and stone disease) was 8.8% and vascular complications 0.8%. Small ureteric leakage (4 patients) was treated by endourologic techniques, whereas leaks associated with ureteral necrosis required open revision. Endourologic treatment was tried in early and mild cases of ureteric obstruction. In late and severe cases, surgery was performed. On univariate analysis the factors that significantly affected the incidence of surgical complications were recipient’s age, lower urinary tract abnormalities, the type of primary urinary recontinuity, the time to diuresis, height and weight of the patients. On multivariate analysis, the type of primary urinary continuity was the only factor that sustained statistical significance. Neither patient nor graft survival was affected by the occurrence of surgical complications. Conclusions: Primary urinary continuity is the only risk factor that affects the incidence of surgical complications among live-donor kidney pediatric renal transplants, with the extravesical technique of Lich-Gregoir giving the best results. Surgical complications in pediatric renal transplantation can be minimized if basic principles of careful transplant technique are used. Prompt identification and treatment of any complication are paramount to graft and patient survival.

RENAL TRANSPLANTATION IN ADULTS WITH ABNORMAL BLADDERS

Since January 1, 1985, we have performed 73 renal transplants in 66 patients with abnormal bladders who had end-stage renal failure as a consequence of urologic abnormalities (mean age 32 years). Their outcome is compared with 58 renal transplants in 54 patients (mean age 40 years) who had renal failure from primary vesicoureteric reflux or renal dysplasia and whose bladder function was considered to be normal. There is no difference in actuarial graft survival in the two groups at 10 years (abnormal 66%, normal bladders 61%), although longer follow-up is showing an advantage for normal bladders, with a kidney half-life of 29 to 33 years compared with 15 years for the abnormal bladder group. Similarly, actuarial patient survival at 10 years is 86% in both groups. Current renal function is better in the group with normal bladders. At latest follow-up, the abnormal, unaugmented bladder group (n=34) has been followed for 92 (87) months (mean [median]) and has a plasma creatinine of 178 (161) micromol/L, whereas the normal bladder group (n=33) has been followed for 104 (93) months and has a creatinine concentration of 143 (140) micromol/L. A strict policy, since 1991, of prophylactic antibiotics for the first 6 months has halved the subsequent incidence of urinary tract infection. Urinary tract infections only produced problems in patients with abnormal bladders. Renal transplantation into the abnormal lower urinary tract is successful but requires careful preoperative evaluation and posttransplant follow-up.

Renal transplantation into the abnormal lower urinary tract.

Renal transplantation into the abnormal lower urinary tract.

Kidney transplantation in patients with an abnormal lower urinary tract

Renal transplantation in patients with lower urinary tract abnormalities is a challenging procedure for both surgeon and patient. The role of patient participation is important while selecting among urinary drainage options. Use of native bladder with or without augmentation is the preferred option if feasible and suitable. Otherwise, urinary diversion is necessary. There is a greater incidence of urinary tract infection in these patients, but overall graft and patient survival remains equivalent to that observed in patients with normal lower urinary tracts. Patients with end-stage renal disease and severe lower urinary tract abnormalities should be evaluated and given the option of renal transplantation if found otherwise suitable.

Renal transplantation in patients with abnormal lower urinary tract

Renal transplantation in patients with abnormal lower urinary tract

Evaluation and management of lower urinary tract disorders in women with multiple sclerosis.

This paper outlines the evaluation and management of the lower urinary tract abnormalities related to voiding function in women with multiple sclerosis (MS). For the pelvic floor reconstructive surgeon, it is important to realize that every patient with MS may have voiding dysfunction unrelated to lower urinary tract symptoms, duration of disease or disability status. Proper evaluation and individualized management of the urinary tract reduces the morbidity and improves the quality of life of patients with this degenerative neurologic disorder.

Urological assessment and complications in renal transplantation

The native urinary tract is an important consideration in the assessment of patients before renal transplantation. Structural or functional problems that could potentially impact on patient or graft outcome should be identified to allow correction or specific management strategies before transplantation. With careful planning, an abnormal lower urinary tract should not be an exclusion because both supravesical diversion and bladder reconstruction can be successfully employed. Urological malignancy may also need to be considered, particularly with an ageing dialysis population. Again, a past history of cancer may not be an exclusion from consideration. In many instances, both prostate and kidney tumours may be detected as incidental findings at an early stage with little likelihood of impacting on the patient's life expectancy for 10 years or more. In these cases, periods of observation before consideration of transplantation may not be required. Techniques employed in the native urinary tract as part of modern urological practice have reduced the incidence and impact of ureteric complications after transplantation. With routine ureteric stenting and percutaneous accessing of the transplant collecting system, less than 1% of patients require open surgery for urological complications.

Experience with kidney transplantation in children and adolescents.

Paediatric kidney transplantation has different aspects in adults in terms of underlying primary renal disease, surgical technique, perioperative care and graft prognosis. Significant urological problems are present in a high percentage of paediatric recipients. This study was undertaken to characterize paediatric kidney transplantation as performed at our institutes. Twenty-eight patients (age range 4-17 years, 10 girls, 18 boys) were included in this study. We analyzed (1) urologic procedures performed prior to or simultaneously with transplantation, (2) intraoperative changes in haemodynamics, (3) postoperative complications and (4) acute allograft rejection and graft prognosis. Of 4 patients with lower urinary tract abnormalities (neurogenic bladder in 3, posterior urethral valve in 1), 2 underwent augmentation ileocystoplasty prior to transplantation. The Mitrofanoff procedure as a diversion for neourethra was also performed in 2 of the 4 patients. All these 4 patients were managed with clean intermittent catheterization. Central venous pressure changes before and after graft vessel declamping were much greater in patients with body weight below 25 kg than in those above 25 kg. Five surgical complications and 6 infections were encountered postoperatively and hypertension was lasting in 6. Thirteen patients experienced 19 periods of acute allograft rejection. All of the 24 patients in the cyclosporin era (1986-) overcame rejections and they are all alive with good graft function. As long as proper pretransplant patient evaluation and management, and intensive perioperative care are undertaken, good prognosis of renal allograft can be achieved in young patients.