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
Graphical AbstractResults.
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 12, 2022
Accepted:
September 8,
2022
Received in revised form:
August 8,
2022
Received:
May 25,
2022
Identification
Copyright
Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
