Evaluation of Voiding Cystourethrography Prior to Renal Transplantation1

Abstract

In many centers, voiding cystourethrography is a routine part of pretransplantation assessment of the lower urinary tract. To assess the value of this investigation, a retrospective review of transplant candidates evaluated in our center over 2 years was undertaken. A total of 517 patients were fully evaluable. Only 13 voiding cystourethrograms (VCUGs) (2.5%) of 517 were found to be abnormal. Three patients with reflux alone did not require intervention before transplantation. Four patients with decreased bladder capacity underwent hydrodistention. Two patients increased their capacity to over 150 ml and two patients failed distention, one requiring an ileal conduit and the other requiring an augmentation cystoplasty. Three patients had increased postvoid residual (PVR). Two patients started clean intermittent catheterization. One required prostate resection for benign prostatic hypertrophy. One patient with reflux and decreased bladder capacity refused treatment. One patient with reflux combined with increased PVR started clean intermittent catheterization and was cleared for transplant surgery. One patient with decreased bladder capacity and increased PVR had a stroke and was excluded from transplantation. All 13 patients with abnormal VCUGs had a prior urologic history. In total, only 56 of 517 patients evaluated had a prior urological history. Each VCUG costs approximately $500. Limiting VCUG studies to those patients with a prior urological history would have resulted in a significant cost savings. Hence, we recommend that only patients with a prior urological history should undergo this costly and often distressing examination.

Incidence, Predictors, and Associated Outcomes of Prostatism after Kidney Transplantation

“…There are no reports of medical therapy use in the renal transplant literature, but, presumably, this would be the first-line therapy as it is in the general population (9). However, medical therapy does add additional drugs to the lifelong drug regimen that already exists in transplant patients, (6) and there is one report of pretransplant TURP in a patient who refused medical therapy (20).…”

“…Evaluation for urologic abnormalities including BPH before transplant listing is generally regarded as necessary, although programs utilize different methods of screening. At a minimum, it has been recommended that this evaluation include a history, examination, urinalysis, urine culture, and upper tract imaging, (14,20,21) for men in whom outlet obstruction is suspected; uroflometry combined with a postvoid residual volume is an excellent objective screening test (14). Once a patient is listed for transplant, BPH surveillance is not standard practice, although one author recommends annual assessment for patients on the waiting list (10).…”

Donated staghorn kidney stone in an HIV positive pediatric kidney transplant recipient

“…The challenge of limited kidney donors to meet the growing demand for organs has contributed to the development of "extended criteria" whereby donors that were not initially considered for donation are now being considered [4]. The incidence of urological abnormalities without a prior history is extremely rare [16,17], thus routine urological assessment is not warranted. For those with a urological history, an evaluation by a urologist should probably be mandatory.…”

Urological challenges in renal transplantation

“…Therefore, formal assessment of the lower urinary tract should be done in all children before transplantation. Voiding cystourethrography is a reliable method of detecting significant abnormalities and has been shown to be a cost efficient means of initial investigation (9).…”