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Aug 28, 2008

Kidney Transplanted

P.R. Sathishkumar (second right) with K.G. Hospital Chairman G. Bakthavathsalam (right) and nephrologist R. Balasubramaniam (left) after he underwent twin surgeries at the hospital in Coimbatore. Surgeons at the K.G. Hospital here have created a urinary bladder for a 27-year-old man and also transplanted a kidney for him in a more than five-hour surgery that sought to give him a new lease of life. “The creation of a bladder using a portion of the small intestine is not a new procedure. Neither is kidney transplantation. But, doing both simultaneously is rare,” hospital Chairman G. Bakthavathsalam told on Tuesday.

Life was normal for P.R. Satish Kumar of Salem till he was 14-years-old. A tumour in the spinal cord had affected a nerve that transmitted signals to the urinary bladder. This had resulted in urinary reflux – a problem that pushed the urine back from the bladder to the kidneys. While on the one hand the kidneys got infected because of the reflux, on the other, this had also cause incontinence – an involuntary release of urine. The tumour was removed in 2003, but because of the neurogenic bladder, urine was not emptied fully. The reflux had gradually caused kidney failure that was initially managed with drugs. As it worsened, dialysis had to be done.

Mr. Suresh Kumar, an employee in a private transport company, was referred to K.G. Hospital in December last year. His condition was evaluated by Chief Nephrologist R. Balasubramaniam and Chief Urologist M. Ramalingam. The patient’s 53-year-old father S. Ramachandran donated a kidney. As Dr. Balasubramaniam and his team got the transplantation process going, Dr. Ramalingam and his team cut out a portion of Mr. Suresh Kumar’s small intestine and converted it into a urinary bladder.

As the patient would not have been able to withstand two surgeries, the surgeons decided to do both the procedures in one surgery, Dr. Bakthavathsalam said. “First, the kidney was transplanted and its compatibility with the patient confirmed. Then the new, artificial bladder was created,” Dr. Balasubramaniam said. “We had to handle this case with extreme care. We were wary of the high infection threat because of the patient being put on drugs to suppress his immune system. This is done to enable the body to accept the donor’s kidney.”

Dr. Balasubramaniam said: “We also had to ensure that there was no leak in the intestine, a portion of which was removed, and also in the new bladder”. The point that the surgeons wanted to prove was that there was a solution to the urinary reflux problem and the kidney failure it caused. “There is the possibility of transplanting the kidney and creating the bladder in a single surgery. So, people with a similar problem and searching for a cure should know that there is indeed one,” he said. On the task ahead, Dr. Balasubramaniam said the artificial bladder would be joined with the original and enable normal functioning.

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