Is Bladder Cycling Useful in the Urodynamic Evaluation previous to Renal Transplantation?

Abstract

Objectives: To evaluate the usefulness of bladder cycling (BC) in differentiating between urodynamic abnormalities due to reversible bladder dysfunction and those due to preexisting lower urinary tract (LUT) abnormalities, and to determine if BC increases the diagnostic yield of urodynamic investigations (UIs) in these patients. Methods: Eleven patients with oligoanuria (<300 ml/day) were evaluated with complete UIs. All cases showed low compliance (mean 6 ml/cm H₂O) and low cystometric capacity (mean 146 ml) and were placed in a BC program. The indications for UIs were LUT symptoms in 2 patients, LUT abnormalities (myelodysplasia or urethral valves) in 3 patients, or the appearance of an extremely small bladder on cystogram (6 patients). BC was performed through a hypogastric catheter in an outpatient setting. UIs were repeated afterwards. Results: After BC, 5 patients (45%) continued to have low compliance (<8 ml/cm H₂O) and 4 patients (36%) had normal UIs. In 2 cases (18%), a previously unrecognized obstruction was diagnosed. No patient with LUT symptoms or abnormalities had a normal UI after BC. Conversely, 4 of 6 patients in whom BC was indicated due to a small bladder on cystogram had normal UIs after BC. Conclusions: BC is useful in explaining whether high bladder pressure is due to dysfunction or to preexisting disorders, and thus indicating the proper surgery for correction. Suprapubic BC significantly increases bladder capacity thus increasing the diagnostic yield of the UI.

Evaluation of video-urodynamic studies before renal transplantation in chronic renal failure patients

“…In a previous study, the patients with low cystometric capacity and low compliance had bladder cycling; however, bladder compliance improved in only 36% of the patients [10]. In other studies, the patients with low detrusor capacity and those with lower urinary tract abnormalities had urinary diversion procedures such as bladder augmentation cystoplasty and ileal conduit before renal transplantation [11][12][13].…”

Lower urinary tract symptoms (LUTS) after renal transplant in non‐urologic anuric patients

“…No kind of bladder recycling was performed in these patients before RTx (10). LUTS were evaluated using a questionnaire adapted from previous scoring systems (11,12) to assess storage and voiding symptoms, bowel habit, and possible influence of symptoms on patientÕs quality of life (Appendix A).…”

“…Fourteen anuric patients fulfilled the inclusion criteria. Median age at RTx was 11 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) yr, median duration of anuria before RTx 24 (7-46) months, and median post-RTx follow-up 2.7 (1.9-10.2) yr. Daytime symptoms were exceptional. Nocturia was the most common symptom (10 patients).…”

Challenges Facing Renal Transplantation in Pediatric Patients With Lower Urinary Tract Dysfunction

“…Some defunctionalized, unstable, small-capacity bladders seem to retain the ability to expand after receipt of the transplant, stabilizing without a deleterious reduction in compliance (40,49,50). Bladder cycling has recently been proposed as a method for distinguishing between potentially reversible urodynamic abnormalities and those that will not regress (3,53). Therefore, the importance of the clinical history in guiding appropriate treatment should not be ignored (52).…”