Kidney Transplant and Ileal Conduit Diversion on the Same Surgical Procedure: Clinical Case and Review of the Literature

Abstract

Introduction: There are multiple causes of end-stage renal disease (ESRD). One of the most uncommon cause is the obstruction of the lower urinary tract due to the development of new endourological procedures and the improvement in clean intermittent catheterization. However, urodynamic problems that require solutions to bladder problems continue to appear that will directly affect the function of the kidney graft. Objective: Clearly state the possibility of performing a bladder conduit technique at the same time as a kidney transplant as an option for patients who undergo kidney transplantation with incompetent bladders. A clinical case is described as an example. Material and Methods: The clinical case of a patient with left cutaneous ureterostomy due to neurogenic bladder who is a candidate for renal transplant is presented. An ileal conduit type urinary diversion is performed in the same surgical act as the renal transplant. The existing literature is analyzed in relation to the different types of urinary diversion and how they affect renal function. Clinical Case and Results: Here we present a 50-year-old male with hypotonic bladder since 19th years old secondary to sacral lipectomy. He developed a progressive deterioration of renal function until he started hemodialysis program in 2018. Ileal conduit and renal transplant are performed through right pararectal incision, reimplantation of the ureter in the antimesenteric side of the intestinal loop. No increase of complications was observed in the post-transplant. The patient was discharged the 7th day after surgery. Serum creatinine at 6 months after renal transplantation 1.2mg/dl. Conclusion: Ileal conduit is a valid resource in patients with neurogenic bladders or with emptying problems whose solution puts at risk the functionality of the graft. Similar recovery is observed in time compared to a kidney transplant without ileal shunt. Post-transplant graft function was good without an increase in complications.