Urodynamics prior to renal transplantation--its impact on treatment decision and final results.
OBJECTIVE
To evaluate the role of urodynamics prior to renal transplantation in a selected group of patients.


METHODS
This retrospective study included 44 consecutive patients (20 males, 24 females; age range 7-57 years; mean age 27.14 +/- 15.17 years) referred for urodynamic evaluation due to known or suspected lower urinary tract dysfunction. End-stage renal disease was due to obstructive uropathy in nine patients, reflux nephropathy in 13, neuropathic bladder in nine and various parenchymal diseases in four; in nine patients the origin of renal failure remained obscure despite detailed investigations. All the patients were subjected to detailed video-urodynamics.


RESULTS
In 30 patients (68.2%) a urodynamic abnormality was found which precluded kidney transplantation into their native bladders without major reconstruction, a minor corrective procedure and/or pharmacotherapy prior to transplantation. More specifically, seven patients were found to have infravesical obstruction, one had a small fibrotic bladder, seven had small capacity bladders due to long-term non-use, four were found on cystometry to have an idiopathic overactive detrusor and 11 exhibited evidence of neurogenic lower urinary tract dysfunction. Fourteen affected patients (32%) were subjected to treatment prior to kidney transplantation: three underwent bladder neck incision, seven recycling of their small bladders, one substitution and three augmentation cystoplasty. Kidney transplantation followed reconstruction 3-18 months later (mean 5 +/- 6.2 months). The follow-up ranged from 12 to 107 months (mean 25 +/- 21 months).


CONCLUSIONS
Urodynamics prior to kidney transplantation in this selected group of patients established a definitive diagnosis of the type of lower urinary tract dysfunction, offered the opportunity for reconstructive surgery and enabled kidney transplantation.
Theodorou
Charalambos
C
Urology Department, Henry Dynart Hospital, Athens, Greece. theod@eexi.gr
Katsifotis
Charilaos
C
Bocos
John
J
Moutzouris
George
G
Stournaras
Pericles
P
Kostakis
Alciviades
A
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014563:Urodynamics