Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function
Tóm tắt
In case of cystectomy, some forms of urinary diversion can impair the graft function of renal transplant patients. Here we present the case of a 70-year-old male with carcinoma of the bladder 12 years after renal transplantation. Immunosuppression was achieved with Cyclosporin A (200 mg/day) and Prednisone (5 mg/day). The patient’s serum creatinine level was 1.4 mg/dl. Following cystectomy, an orthotopic ileal neobladder was constructed by means of Studer technique, and the afferent ileal loop was anastomosed to the graft ureter. Pathology revealed pT1 G3 N+ transitional cell carcinoma. Ten months later, periaortic nodal recurrences necessitated four cycles of chemotherapy with Epidoxorubicyn and Gemcytabine. To date, 20 months after cystectomy, the patient is stable, with day and night-time urinary continence. His serum creatinine level is 1.3 mg/dl, and there is no evidence of hydronephrosis or acidosis. We conclude that the orthotopic ileal neobladder is an effective form of urinary diversion in renal transplant patients requiring cystectomy, allowing good preservation of the renal function.
Tài liệu tham khảo
Thon WE, Kliem V, Truss MC, Anton P, Kuczyk M, Stief CG, Brunkhorst R. De novo urothelial carcinoma of the upper and lower urinary tract in kidney-transplant patients with end-stage analgesic nephropathy. World J. Urol. 1995; 13:254.
Mc Credie M, Stewart JH, Ford JM, Mc Lellan RA. Phenacetin containing analgesics and cancer of the bladder or the renal pelvis in women. Brit. J. Urol. 1983; 55:220.
Srinivas V, Deshmukh R, Shah B, Kapadia A. Radical cystectomy for invasive squamous cell carcinoma in a renal transplant patient. Urol. Int. 1993; 51:167.
Perabo FG, Schultze-Seeman W. Continent orthotopic ileal neobladder after kidney transplant in a female patient with multifocal transitional cell carcinoma. J. Urol. 1998; 159:1635.
Colombo T, Zigeuner R, Zitta S, Petrisch PH, Hubmer G. Orthotopic neobladder in a woman after kidney transplantation. J. Urol. 1997; 158:2236.
EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: Long-term management of the transplant recipient. IV.6.3. Cancer risk after renal transplantation. Solid organ cancers. prevention and treatment. Nephrol. Dial. Transplant. 2002; 17 [suppl. 4] 32.
Shokeir JA, Shamaa MA, Abol-Enein H, El-Mekresh M, Ghoneim MA. Post transplant urethral Kock pouch. Scand. J. Urol. Nephrol. 1994; 28:315.
Giessing M, Turk I, Schoenberger B, Loening SA. Orthotopic neobladder after kidney transplantation in a male patient with recurring urothelial carcinoma and renal cancer. J. Urol. 2001; 166:1383.
Koutani A, Lechevallier E, Coulange C. Infiltrative bladder tumor in a renal transplant patient. cystectomy with prostatic conservation and enterocystoplasty. Progr. Urol. 1997; 7:277.
Marechal JA, Sanseverino R, Gelet A, Martin X, Salas M, Dubernard JM. Continent cutaneous ileostomy (Kock pouch) prior to renal transplantation. Brit. J. Urol. 1990; 65: 317.
Studer UE, Zingg EJ. Ileal orthotopic neobladder substitution. What we have learned from 12 years experience with 200 patients. Urol. Clin. N. Am. 1997; 24:781–793.
Coxton JP, Jones CR. Two cases of patients with renal transplants presenting with anuria due to an infarcted ileal conduit. Transpl. int. 2002; 15:515.