Bladder Evaluation and Management Before a Pediatric Kidney Transplant

At Children’s Hospital Colorado, our transplant team is dedicated to giving your child the best possible kidney transplant outcome. This includes making sure that your child’s other organs are ready for a new kidney.

Why do we evaluate the bladder before a kidney transplant?

Many children and young adults who have chronic kidney disease and need a kidney transplant have problems with their bladder. If your child’s bladder doesn’t empty as it should, this can lead to urinary tract infections, the return of urine into the kidneys from the bladder and increased pressure in the kidneys. All of these bladder concerns put your child’s kidney transplant at risk of damage.

To prevent any unnecessary risks, our pediatric urologists evaluate your child’s bladder before getting a kidney transplant. We ensure that his or her bladder is working as it should and that it won’t cause harm to the new kidney. If we find that the bladder is not safe, then we can treat the bladder to help it become safe for a new kidney.

How do pediatric urologists evaluate your child’s bladder?

At Children’s Colorado, our pediatric urologists complete a multi-step evaluation of the bladder.

1. First, we ask you or your child questions about emptying his or her bladder. This helps us know if there are problems with controlling the emptying bladder and if your child has had urinary tract infections in the past.
2. Second, we ask your child to empty his or her bladder into a special toilet. This is called an uroflow test, which provides urologists information about how your child urinates and how the bladder and control mechanism (sphincter) works.
3. Third, an ultrasound scan of the bladder is taken to check how much urine is left.
4. Lastly, some patients need an urodynamics test, where a catheter is placed into the bladder to inject dye so urologists can measure the bladder pressure. This test typically lasts 30 minutes.

What do we do next?

If your child’s bladder is working normally, then we inform the transplant team that his or her bladder is safe for a new kidney.

If the bladder is not working normally, then we decide how to treat your child’s bladder together. The common concerns are that the bladder cannot store the urine or get rid of the urine as it should.

If the bladder cannot store urine properly, treatment options include:

• Medicine to relax the bladder so that the bladder can hold more urine under less pressure.
• Botox injections into the bladder repeated every six months, which helps to relax the bladder so it can hold more urine.
• An operation called a bladder augmentation to make the bladder bigger. This surgery can be done either before or after the kidney transplant. 

If the bladder cannot get rid of urine properly, treatment options include:

• Teaching your child how to empty his or her bladder better; this is sometimes taught by a pediatric physical therapist.
• Taking medicine to relax the control mechanism (sphincter) in the bladder.
• Emptying the bladder by using a catheter every few hours. If this is necessary, we will teach you and your child how to do it and make sure you are comfortable. 
• An operation, where a tube goes into the bladder from outside of the skin so your child can empty the bladder with a catheter every few hours. This option is rarely needed.

Why choose Children’s Hospital Colorado for your child’s kidney transplant?

At Children's Colorado, our Kidney Transplant Program has complete pediatric-focused, multi-specialty expertise. As a multidisciplinary team with over 25 years of experience, we provide care from diagnosis through evaluation and from surgery through life after the transplant. Our complete care gives our patients’ new kidneys the best chance of success in the body.

Our dedicated transplant team that includes:

• Pediatric transplant nephrologist (kidney specialist)
• Pediatric transplant surgeon
• Pediatric anesthesiologists
• Pediatric urologists
• Pediatric nurses
• Pediatric clinical psychologists
• Pediatric dietitians
• Pediatric social workers
• Transplant coordinators 

Learn how our Transplant Program has been changing lives for more than 25 years.