title: [Lower urinary tract symptoms and pelvic floor dysfunction in renal transplant candidates and recipients].
abstract: OBJECTIVE
  To describe lower urinary tract symptoms (LUTS) and their management in renal transplant candidates and recipients.
  
  
  METHODS
  Relevant publications were identified through Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) database using the following keywords, alone or in association: "transplantation", "prostate hyperplasia", "transurethral resection of prostate", "urinary incontinence", "LUTS", "pelvic floor dysfunction". Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and case reports were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 991 articles were analyzed and after careful selection, 47 publications were eligible for our review.
  
  
  RESULTS
  Reduction of bladder capacity, due to dialysis and anuria, is correlated with dialysis duration. This reduction is reversible after renal transplantation and does not seem to put renal transplant recipients at risk for medical complications. Transplant procedure generally allows restoration of bladder maximal output, normal bladder capacity and compliance. Medical treatment of LUTS related to prostate hyperplasia (BPH) includes alpha-blockers and finasteride. Silodosin and dutasteride have not been evaluated in that setting. Antimuscarinics may be used with caution, and favor the use of solifenacin at 5mg per day. Surgical treatment of BPH requires a preserved urine output, otherwise must be delayed after transplantation; it may thus be performed safely in the early postoperative course. Botulinum toxin injections and surgical treatment of stress incontinence and prolapse are barely reported in this population.
  
  
  CONCLUSIONS
  Precise assessment and optimal management of LUTS in renal transplant candidates and recipients are critical to improve quality of life and to preserve allotransplant function. Literature data lack evidence to propose robust recommendations. However, knowledge of reported specificities in this peculiar setting is mandatory for urologists to provide patients with finest options and optimal treatment timing.
authors.affiliation: Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France. Electronic address: rodolphe.thuret@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Thuret
authors.affiliation: Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Hurel
authors.affiliation: Service d'urologie et transplantation rénale, CHRU de Besançon, 25030 Besançon, France; Université de Franche-Comté, 25030 Besançon, France; Inserm UMR 1098, 25030 Besançon, France.
authors.forename: F
authors.initials: F
authors.lastname: Kleinclauss
authors.affiliation: Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France.
authors.forename: M O
authors.initials: MO
authors.lastname: Timsit
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D059411:Lower Urinary Tract Symptoms / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D059952:Pelvic Floor Disorders / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011470:Prostatic Hyperplasia / Q000150:complications; D014563:Urodynamics
keywords: Hyperplasie prostatique; Incontinence urinaire; Pelvic organ prolapse; Pelvic reconstructive surgery; Prostate hyperplasia; Prostatism; Résection transurétrale de la prostate; Sacral colpopexy; Statique pelvienne; Transplantation; Transurethral resection of prostate; Troubles mictionnels; Urinary incontinence