Lower urinary tract symptoms and their impact on quality of life after successful renal transplantation

Abstract

Objective: To investigate lower urinary tract symptoms (LUTS) and their impact on quality of life (QOL) in patients having undergone renal transplantation (RTX). Methods: Forty-three patients (25 males and 18 females; age 20-68 years) undergoing RTX at Hokkaido University Hospital were included in this study. Median follow-up after RTX was 41 months (range 6-184). Pre-transplant dialysis had been carried out in 38 patients (median: 4.3 years, range: 1 month-31 years). All patients were assessed by uroflowmetry (UFM), postvoid residual urine volume (PVR), 24 h bladder diary, and International Prostate Symptom Score (IPSS). QOL score and King's Health Questionnaire (KHQ) were used for the assessment of LUTS-related QOL. Results: Mean fluid intake volume and urine output volume for 24 h were 2136 mL (1150-3430 mL) and 2446 mL (1336-4733 mL), respectively. Voiding dysfunction assessed by UFM and PVR was observed in 12 patients (28%) showing higher IPSS. QOL score and overall QOL in KHQ were not different between patients with and without voiding dysfunction. Although 19 (49%) had polyuria, 20 (51%) had nocturnal polyuria, which affected nocturia in IPSS as well as sleep/energy disturbances in KHQ compared with patients without nocturnal polyuria. Conclusions: Patients having RTX frequently present voiding dysfunction and nocturia basically caused by nocturnal polyuria. We should focus on LUTS in these patients to provide an appropriate management.

Risk Factors for Lower Urinary Tract Dysfunction and Symptoms After Successful Renal Transplantation

“…A previous study reported that LUT dysfunction and LUT symptoms did not significantly affect the QOL of patients who underwent RTX [19], except for nocturia and nocturnal polyuria [9]. However, these findings are controversial because patients who underwent RTX do not need renal replacement therapy and may perceive changes in LUT symptoms as positive.…”

“…Dion et al reported that low urine output before RTX was predictive of LUT symptoms, which were not uncommon after RTX [20]. Voiding dysfunction has also been frequently observed in patients who underwent RTX [7][8][9]. Thus, screening for LUT symptoms and LUT dysfunction is important, even in patients who successfully underwent RTX, because they may induce urinary tract infections and vesicoureteral reflux and their related complications.…”

“…In non-neurogenic patients, adaptation of the LUT typically occurs within 6 months of RTX [6] if the glomerular filtration rate and urine output fully recover. However, some patients develop LUT dysfunction and LUT symptoms, which can impact on QOL [7][8][9]. Particularly, more than a half of patients with RTX frequent micturition and nocturia, which persisted for many years [10,11].…”

“…Furthermore, patients who undergo RTX are instructed to take ample amounts of fluid in order to preserve renal function; however, this may affect LUT symptoms. We previously showed that some patients who successfully underwent RTX developed nocturnal polyuria and nocturia, which affected their QOL [9]. On the other hand, LUT dysfunction may cause urinary tract infection [8], which could affect survival of renal graft [12][13][14].…”

The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation

“…It should be known that it is very difficult to predict incidence of BPH because of dialysis-dependent oliguric or anuric life span. [11] When the outcomes of end-stage renal failure patients who had undergone TURP with the diagnosis of BPH before transplantation were evaluated, oliguric, and anuric state of these patients were observed to be a high risk for the postoperative development of bladder neck stricture. [12] Therefore, it has been suggested that surgeries should be deferred after transplantation in patients diagnosed as BPH irrespective of their oliguric or anuric state before transplantation because of higher incidence of postoperative morbidity.…”