Evaluation of the Lower Urinary Tract before Renal Transplantation: To Which Patients? How?

Adnan Simsir, Hamad Dheir, Rashad Mammadov, Cuneyt Hoscoskun, Huseyin Toz, Ercan Ok, Ceyhun Ozyurt

Department of General Surgery, Ege University School of Medicine, Izmir, Turkey.
Department of Urology, Ege University School of Medicine, Izmir, Turkey.
Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.

DOI: 10.4236/oju.2012.23022                

Abstract

Purpose: The evaluation of lower urinary tract (LUT) before transplantation is not required, except in patients with a history of LUT disfunction (LUTD). In this study, we adressed the necessity for lower urinary system evaluation in transplantation candidates classified according to their etiology. Materials and Methods: Sixty-two patients were prospectively evaluated. The patients were evaluated at 2 months preoperatively and at 6 months post transplantation using questionnaires, bladder diary and urodynamic studies. The end stage renal disease (ESRD) etiologies of the patients were divided into three groups as follows: patients with a parenchymal disease, patients with LUTD and those with unknown etiology and the obtained results were evaluated accordingly. Results: The evaluation of 50 patients revealed significant differences in ICIQ-SF (p < 0.001), IPSS (p < 0.001), daily urine volumes (p = 0.05), maximum urinary flow rate (p = 0.03), PVR, the number of patients with VUR and all cystometric parameters between the patient groups divided according to the etiology. The comparison of the groups to each other revealed no statistically significant differences in all parameters between the LUTD group and the patient groups with unknown etiology. Considering that the results from questionnaires of patients with a single voided volume of 100 cc or greater on the bladder diary would be scientifically more significant, they were evaluated separately. Thus, even though the results from questionnaires did not differ between the group with unknown etiology and the LUTD group, there were significant differences when compared to patients who developed ESRD due to a parenchymal disease. Similar findings were found between the results of urodynamic study. Conclusions: The evaluation of lower urinary tract in patients with a history of LUTD and in those with unknown etiology should be initially evaluated by noninvasive methods such as questionnaires and uroflowmetry.

Keywords

Renal Transplantation; Lower Urinary Tract; Evaluation; Urodynamics

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. Shapiro, “Outcome after Renal Transplantation,” In: R. Shapiro, R. L. Simmons and T. E. Starzl, Eds., Renal Transplantation, Appleton Lange, London, 1997, p. 1.
[2]	B. L. Kasiske, “The Evaluation of Prospective Renal Transplant Recipients and Living Donors,” Surgical Clinics of North America, Vol. 78, No. 1, 1998, pp. 27-39. doi:10.1016/S0039-6109(05)70632-0
[3]	M. Campise, “Selection and Preparation of the Recipient,” In: B. D. Kahan and C. Ponticelli, Eds., Principles and Practise of Renal Transplantation, Martin Dunitz, London, 2001, pp. 89-143.
[4]	J. McCauley, “Evaluation of Potential Renal Allograft Recipient,” In: R. Shapiro, R. L. Simmons and T. E. Starzl, Eds., Renal Transplantation, Appleton Lange, London, 1997, pp. 43-72.
[5]	R. E. Power, D. P. Hickey, D. M. Little, “Urological Evaluation Prior to Renal Transplantation,” Transplantation Proceedings, Vol. 36, No. 10, 2004, pp. 2962-2967. doi:10.1016/j.transproceed.2004.11.006
[6]	K. Shandera, A. Sago, J. Angs, et al., “An Assesment of the Need for Voiding Cystourethrogram for Urologic Screening, Prior to Renal Transplantation,” Clinical Transplantation, Vol. 7, No. 4, 1993, pp. 299-301.
[7]	W. Schafer, P. Abrams, L. Liao, et al., “Good Urodynamic Practices: Uroflowmetry, Filling Cystometry, and Pressure-Flow Studies,” Neurourology and Urodynamics, Vol. 21, No. 3, 2002, pp. 261-274. doi:10.1002/nau.10066
[8]	K. Shandera, T. A. Rozanski and G. Jaffers, “The Necessity of Voiding Cystourethrogram in the Pretransplant Urologic Evaluation,” Urology, Vol. 47, No. 2, 1996, pp. 198-200. doi:10.1016/S0090-4295(99)80415-4
[9]	A. Sharfuddin, “Imaging Evaluation of Kidney Transplant Recipients,” Seminars in Nephrology, Vol. 31, No. 3, 2011, pp. 259-271. doi:10.1016/j.semnephrol.2011.05.005
[10]	B. Kalb, D. R. Martin, K. Salman, P. Sharma, J. Votaw and C. Larsen, “Kidney transplantation: Structural and Functional Evaluation Using MR Nephro-Urography,” Journal of Magnetic Resonance Imaging, Vol. 28, No. 4, 2008, pp. 805-822. doi:10.1002/jmri.21562
[11]	S. M. Friedewald, E. P. Molmenti, J. J. Friedewald, M. R. Dejong and U. M. Hamper, “Vascular and Nonvascular Complications of Renal Transplants: Sonographic Evaluation and Correlation with Other Imaging Modalities, Surgery, and Pathology,” Journal of Clinical Ultrasound, Vol. 33, No. 3, 2005, pp. 127-139. doi:10.1002/jcu.20105
[12]	H. P. Koo, T. E. Bunchman, J. T. Flynn, et al., “Renal Transplantation in Children with Severe Lower Urinary Trcat Disfunction,” The Journal of Urology, Vol. 161, No. 1, 1999, pp. 240-245. doi:10.1016/S0022-5347(01)62119-0
[13]	J. Barry, “Kidney Transplantation into Patients with Abnormal Bladders,” Transplantation, Vol. 77, No. 3, 2004, pp. 1120-1123. doi:10.1097/01.TP.0000116711.59454.F1
[14]	R. H. Jefferson and J. R. Burns, “Urologic Evaluation of Adult Renal Transplant Recipients,” The Journal of Urology, Vol. 153, No. 3, 1995, pp. 615-618. doi:10.1097/00005392-199503000-00016
[15]	C. C. Yang, M. C. Rohr, D. G. Assimos, “Pretransplant Urologic Evaluation,” Urology, Vol. 43, No. 2, 1994, pp. 169-173. doi:10.1016/0090-4295(94)90038-8