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Revision ureteroneocystostomy in pediatric renal transplant patients for symptomatic vesicoureteral reflux and its effect on recurrent hospitalizations

Published:September 12, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.09.006

      Summary

      Background

      Nearly 13,000 pediatric renal transplantations have been performed since 1987 with improving overall mortality and morbidity; however, graft infection remains a significant post-transplant concern. Recurrent urinary tract infections in pediatric patients with vesicoureteral reflux into their renal transplant can result in graft dysfunction, increased hospital cost, and impaired social and cognitive development due to time spent hospitalized.

      Objective

      To evaluate the effect of revision ureteroneocystostomy on pediatric renal transplant patients with symptomatic vesicoureteral reflux in reducing hospitalizations and recurrent urinary tract infections.

      Methods

      We retrospectively reviewed pediatric patients from 2002 through 2021 who underwent renal transplantation and required revision ureteroneocystostomy due to symptomatic vesicoureteral reflux. We analyzed the differences in days hospitalized, days hospitalized due to urinary tract infection, and treated urinary tract infections prior to and after revision ureteroneocystostomy.

      Results

      Ten patients requiring revision ureteroneocystostomy secondary to symptomatic vesicoureteral reflux were identified. There was no difference in the observation time between transplant to revision, and revision to last follow up (2.3 years (IQR 1.3–6.5) vs 1.7 years (IQR 1–6.7), p = 0.4446). Overall, there was a significant decrease in the total number of hospitalization days (21.5 days (IQR 3–43) vs 5.5 days (IQR 0–9), p = 0.006), total number of hospitalization days related to urinary tract infection (14.5 days (IQR 3–28) vs 0 days (IQR 0–3), p = 0.008) and treated urinary tract infections (3.5 (IQR 3–6) vs 1 (IQR 0–2), p = 0.019) following revision ureteroneocystostomy. The rate of hospitalization days for urinary tract infection was also significantly decreased following revision ureteroneocystostomy (7.15 per/year (IQR 0.4–11.75) vs 0 per/year (IQR 0–0.8), p = 0.008).

      Discussion

      Symptomatic vesicoureteral reflux in pediatric transplant patients is difficult to manage and some patients will ultimately require surgery. There have been previous studies on the success of revision ureteroneocystostomy in treating reflux but no data on the reduction in hospitalizations associated with recurrent infections following the procedure. Limitations of this study are the small cohort size, retrospective nature, multi-surgeon study, and inherent selection bias due to evaluation of only surgical patients.

      Conclusion

      Summary Fig

      Keywords

      Abbreviations:

      CAKUT (Congenital Anomalies of the Kidney and Urinary Tract), DD (Deceased Donor), ESRD (End Stage Renal Disease), LD (Living Donor), QoL (Quality of Life), rUNC (Revision Ureteroneocystostomy), UTI (Urinary Tract Infections), VUR (Vesicoureteral Reflux), VCUG (Voiding Cystourethrography)
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