UroToday - A study from Brazil evaluated kidney transplantation in relation to urinary tract infection and bladder augmentation. This study showed 23 children who had undergone bladder augmentation and then had renal transplantation were retrospectively compared to 42 controls matched for gender, age, race, donor type, weight, and immunosuppression protocol in regards to graft outcome.

Of no surprise, the group found that patients with augmented bladders had more asymptomatic bacteriuria. However, they also found that urinary tract infections in patients with augmented bladder in kidney transplantation were increased over the controls. They also found that the graft survival rate was the same between the 2 groups.

An editorial comment by Dr. Martin Koyle reiterates that infectious complications, including UTIs, continue to be a common sequela of transplantation and immunosuppression irrespective of bladder status.

He also states that it is challenging to differentiate between colonization and true urinary tract infection in these high-risk patients who have undergone augmentation on clean intermittent catheterization and an immunosuppressionant.

He agrees with the tendency to treat significant bacteriuria in the first 6 months after transplantation. He further mentions that bladder perforation is a life-threatening emergency. He is surprised that there are such few case reports. We must stress clean intermittent catheterization and irrigation of the augmentation to ensure that the bladder is under low pressure. Overnight catheter drainage may also be part of the armamentarium to help these children keep low pressures in their bladder in the light of immunosuppression.

Pereira DA, Barroso U Jr, Machado P, Pestana JO, Rosito TE, Pires J, Almeida C, Ortiz V, Macedo A Jr
J Urol. 2008 Dec;180(6):2607-10

UroToday Medical Editor Pasquale Casale, MD

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