Total anatomic urinary tract replacement and renal transplantation: a surgical strategy to correct severe genitourinary anomalies.

During renal transplantation, the donor ureter is normally anastomosed to the recipient bladder. However, preexisting anomalies of the lower urinary tract or previous surgical interventions may render the recipient bladder unusable. Although in such situations urine may be externalized via cutaneous ureterostomy or an ileal conduit, both techniques are frequently complicated by bacterial colonization or chronic infection. To overcome these problems, the authors have been treating such children via extensive, staged, bladder reconstruction (augmentation) before transplantation. On rare occasions, however, the absence of a usable bladder necessitates the creation of a complete neobladder from other visceral tissues. The authors present two cases in which patients underwent complete anatomic reconstruction of the lower urinary tract before renal transplantation. This approach results in the optimal environment for allograft function and leads to a greater rehabilitation than that achieved with urinary diversion.