This paper examines the evidence concerning the timing, indications and problems associated with augmentation cystoplasty (AC), posterior urethral valves (PUV), and end stage renal failure (ESRF) using a literature review via Medline, Cochrane library and LILACS databases. Two search strategies were used: one without limits and one with age limits 0-18. A total of 186 abstracts were retrieved of which 47 were reviewed. There were no prospective studies and all available evidence corresponded to level 3 or 4. The auditors commented that as valve bladders change over time (hypertonic bladders are present in 66% of < five-year-olds vs. 15% of 13-year-olds), that the management of transplant immunosuppressive has changed considerably over the time period of review (20 years), and that the care of valve bladders with clean intermittent catheterisation (CIC) had improved over time, it was almost impossible to reach a comprehensive conclusion. However, it was clear that a number of broad concepts could be agreed upon following the review:

  1. Renal transplantation is feasible in non-augmented bladders.
  2. Urinary tract infections (UTI) are frequent in PUV transplanted patients and are likely to be due to bladder dysfunction.
  3. Transplantation into augmented bladders increases the risk of UTI because of mucus accumulation and occasional oliguria.
  4. Spontaneous changes to valve bladders are likely to occur with age making them underactive.
  5. There are significant complications associated with augmentation cystoplasty.

The authors conclude from their review that pre-emptive augmentation cystoplasty in children with PUV should only be constructed in selected cases where the risks associated with increased bladder pressures exceed the ones arising from the augmentation procedure and UTI. 

Pre-transplant management of valve bladder: a critical literature review.
Jesus LE, Pippi Salle JL.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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