Clinical Characteristics of Renal Transplant Recipients that Underwent Urologic Surgery for de novo Disease Before and After Transplantation

Abstract

The pre-transplantation goal of the urologist is the optimization of urinary tract condition. Therefore, urologic surgery may be needed before or after renal transplantation. We analyzed the results of urologic surgery performed because of de novo urologic diseases. Between January 1986 and January 2001, 281 patients underwent renal transplantation, and 23 urologic surgical procedures were performed on 21 transplant recipients before or after renal transplantation because of de novo urologic diseases. By review the major reasons for urologic surgery in recipients were polycystic kidney diseases, vesicoureteral reflux, and dysfunctional voiding disorders. Nineteen surgical corrective procedures were done average 2.9 months before transplantation. The mortality rate was 10.5%. Four patients underwent urologic surgery at an average 57.5 months after transplantation. We highlight the fact that patients with uremia are vulnerable to surgical complications, and conclude that more intensive long-term urologic follow-ups should be conducted on recipients.

Minimal-invasive management of urological complications after kidney transplantation

“…If surgical deobstruction e.g. with transurethral resection of the prostate (TUR-P) is indicated, it may either be performed prior [ 17 ] or after KT, although low or missing urine output before transplantation seems to promote bladder neck and urethral scarring [ 18 ]. In analogy, urethral strictures can be safely treated endoscopically with urethrotomy or open reconstruction surgery in dependence of the extent and the localization of the stricture [ 19 , 20 ].…”

“…In specific indications prior to transplantation, native nephrectomy may become necessary: unilateral or bilateral nephrectomy can improve pre-transplant clinical conditions of the patient in case of large proteinuria, UTI on the basis of VUR [ 25 ], and hypertension [ 26 ]. In cases of large polycystic kidneys, nephrectomy creates intraabdominal space and may remit possible symptoms like abdominal or flank pain, recurrent cyst infections or recurrent bleeding due to rupture of cysts [ 17 ].…”