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Utility of pre-transplant bladder cycling for patients with a defunctionalized bladder. A randomized controlled trial

  • Author Footnotes
    a Yasser Osman, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Yasser Osman
    Footnotes
    a Yasser Osman, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Affiliations
    Urology department, Urology and Nephrology Center, Mansoura University, Egypt
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  • Mohamed H Zahran
    Correspondence
    Corresponding author: Mohamed H Zahran, Associate professor of urology, Urology and nephrology center, Mansoura University, Egypt, Telephone: +20502202222, Fax: +2050226371
    Affiliations
    Urology department, Urology and Nephrology Center, Mansoura University, Egypt
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  • Author Footnotes
    b Ahmed M Harraz, Associate professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Ahmed M Harraz
    Footnotes
    b Ahmed M Harraz, Associate professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Affiliations
    Urology department, Urology and Nephrology Center, Mansoura University, Egypt
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  • Author Footnotes
    c Mohamed Elsayed Mashaly, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    Mohamed Mashally
    Footnotes
    c Mohamed Elsayed Mashaly, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    Affiliations
    Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
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  • Author Footnotes
    d Ahmed I Kamal, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    Ahmed I. Kamal
    Footnotes
    d Ahmed I Kamal, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    Affiliations
    Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
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  • Author Footnotes
    e Bedeir Ali-El-Dein, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Bedeir Ali-El-Dein
    Footnotes
    e Bedeir Ali-El-Dein, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    Affiliations
    Urology department, Urology and Nephrology Center, Mansoura University, Egypt
    Search for articles by this author
  • Author Footnotes
    a Yasser Osman, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    b Ahmed M Harraz, Associate professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
    c Mohamed Elsayed Mashaly, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    d Ahmed I Kamal, Clinical fellow of nephrology, Nephrology department, Urology and Nephrology Center, Mansoura University, Egypt
    e Bedeir Ali-El-Dein, Professor of urology, Urology and Nephrology Center, Mansoura University, Egypt
Published:January 18, 2023DOI:https://doi.org/10.1016/j.urology.2023.01.008

      ABSTRACT

      Objectives

      To study the necessity of pre-transplant programmed bladder cycling (PBC) in patients with defunctionalized bladder (DB).

      Methods

      This RCT included renal transplant (RT) candidates with DB. Eligible patients were assigned to two groups, group I underwent PBC before RT and group II underwent direct RT into the DB. The primary outcome was to assess the efficacy of PBC in improving post- RT bladder capacity. Secondly, to compare its impact on early urological complications and 3-month voiding function and 1-year graft function and survival. Graft function was evaluated using serum creatinine and eGFR using MDRD equation.

      Results

      Groups I included 23 patients and group II included 20 patients. The mean ±SD of bladder capacity was 88.7±11.7ml and 90.6 ±9.8ml in both groups, respectively (P= 0.5). In group I, PBC increased bladder capacity to 194.7 ±21.2 ml (P<0.001). Targeted bladder capacity was achieved in 19 (82.6 %) patients and two patients developed UTI. At 3-months, bladder capacity, compliance and bladder contractility index improved significantly in both groups with a significant reduction in maximum detrusor pressure with no significant difference between both groups (P= 0.3,0.4, 0.2 and 0.8, respectively). Urinary leakage occurred in one (4.3%) and three patients (15%) in group 1 and 2, respectively (P=0.2). At 1-year, no statistically significant differences in the median (IQR) serum creatinine (P= 0.05) and eGFR (P= 0.07) between both groups were noted.

      Conclusions

      Pre-transplant PBC for DB-patients provided no clinical advantage concerning postoperative urological complication, urodynamic criteria and graft function and survival.

      KEY WORDS

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