Postoperative Voiding Dysfunction in Older Male Renal Transplant Recipients

Tsaur, Igor; Jones, Jon; Melamed, R.J.; Blaheta, Roman A.; Goßmann, Jan; Bentas, Wassilios

doi:10.1016/j.transproceed.2009.01.110

Cited by 31 publications

(29 citation statements)

References 8 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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]. Thus, we need to focus on LUT dysfunction and LUT symptoms after successful RTX, because it is currently an important issue to improve the QOL of patients with RTX as well as a survival rate of renal graft.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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Background:We investigated risk factors for lower urinary tract (LUT) dysfunction and LUT symptoms in patients who successfully underwent renal transplantation (RTX). Material/Methods:Ninety-five patients (54 males and 41 females) undergoing RTX (median age: 45 years old) at Hokkaido University Hospital were included in this study. Uroflowmetry (UFM), postvoid residual urine volume (PVR), and 24-h bladder diaries were performed. We analyzed risk factors for voiding dysfunction, urinary frequency, polyuria, nocturia, and nocturnal polyuria after RTX using logistic regression analysis. Results:End-stage renal disease arose from diabetes mellitus in 18 patients (19%). Pre-transplant dialysis had been carried out in 74 patients. Voiding dysfunction as assessed by UFM and PVR was observed in 24 patients (27%).Based on the 24-h bladder diaries, we identified frequent micturition in 29 patients (35%), polyuria in 44 (54%), nocturia in 30 (37%), and nocturnal polyuria in 46 (56%). A multivariable logistic regression analysis revealed that diabetes mellitus, which may cause autonomic disorders, was a risk factor for voiding dysfunction and nocturnal polyuria. A risk factor for frequent micturition and nocturia was older age at RTX. Being female was a risk factor for polyuria, which suggested that fluid intake in relation to body weight was higher in females. Conclusions:LUT dysfunction and LUT symptoms were not uncommon in patients who successfully underwent RTX. LUT dysfunction and LUT symptoms need to be considered in patients with risk factors such as diabetes mellitus, older age at RTX, and being female, even after successful RTX.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…Once these men undergo technically successful transplantation and restoration of urine production, voiding dysfunction may newly become sufficiently significant to require the use of a medication or an invasive procedure for management. Tsaur et al [11] did find a 27% incidence of posttransplantation voiding dysfunction in newly transplanted men aged 60 years and older; BPH was the cause in 93% of these patients, of whom 81% required surgical resection at a mean of 31 days after transplant. On the other hand, identification of clinically relevant BPH through objective testing is notoriously challenging, particularly in ESRD.…”

Section: Which Patient?mentioning

confidence: 99%

Cautious Renal Transplantation for the Elderly Is Realistic

Friedman¹

2011

Nephron Clin Pract

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Excellent results of transplantation in elderly recipients, together with regulatory requirements encourage continued consideration of this modality. The organ shortage compels the use of deceased-donor kidneys and may be a suboptimal therapy. However, the elderly patient may not tolerate the prolonged wait for an optimal organ. While individual comorbidities can be evaluated, patient selection requires the transplantation team to render a judgment based on the candidate’s overall condition, which is best correlated with the ability to accomplish activities of daily living and to perform moderate exercise. Psychosocial considerations are complex in the elderly patient because of frequent dementia, absence of a sufficient support mechanism and the need for more resources than those required by younger patients. After transplantation, appropriate management of immunosuppression typically entails lower doses in elderly patients, a logical consequence of immunosenescence. Transplantation should not be considered an acceptable exercise in futility when the ability to offer this life-saving therapy to other patients will be adversely affected by doing so.

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“…[4] Although scarce number of articles have investigated BOO emerging after RT, investigators recommend treatment soon after RT. [5][6][7] Nevertheless, inadequate literature data exist concerning short-, and long-term urological outcomes of TURP, and TUIP performed especially within the first 30 days after RT. The objective of this study is retrospective evaluation of the outcomes of TURP, and TUIP performed for the relief of urinary retention developed secondary to BOO within the short term after RT.…”

Section: Introductionmentioning

confidence: 99%

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

Sarıer

Duman

Demir

et al. 2018

Turkish Journal of Urology

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Objective: In the early period after renal transplantation, urinary retention stemming from bladder outlet obstruction (BOO) may directly affect graft success. The aim of this study was to evaluate the early and long-term outcomes of transurethral resection of the prostate (TURP) and transurethral incision of prostate (TUIP) procedures performed in the first month following RT due to BOO. Material and methods:Between February 2009 and March 2016, 38 male patients underwent TURP/ TUIP due to BOO within the first 30 days of renal transplantation. The urodynamic and renal function assessment results of all patients were collected during the pre-and postoperative periods. All patients were followed up for a minimum of 12 months for short and long-term complications. The results were evaluated retrospectively. Results:The mean age of the patients who underwent operations was 59.2±12 years. The median duration of dialysis was 41 months (range 0-180). Before the operation the mean serum creatinine (sCr) level was 1.8±0.7 mg/dL, the mean total PSA level was 1.6±1.1 ng/mL. Of the voiding parameters, the mean Qmax and Qave were measured as 8.2±4.5 mL/sec and 4.6±2.5 mL/sec, respectively. The median post-micturition residual urine (PMR) was 105 mL (range 10-400). TURP/TUIP operations were performed at a median of 19 days (range 8-30) after renal transplantations. None of the patients experienced major complications. In the early postoperative period, 5 patients (13.1%) developed urinary tract infection. The mean decrease in sCr in the first month following TURP/TUIP was 1.4±0.4 mg/dL (p<0.001). The mean Qmax (22.4±11.1 mL/sec), and Qave (11.7±5.4 mL/sec) increased significantly (p<0.001), while the median PMR (15 mL, range 0-205) decreased significantly (p<0.001). The mean follow-up period after the procedure was 46.8±23.3 months. During the follow-up period, 3 (7.8%) patients suffered from urethral stricture and 2 (5.2%) patients from bladder neck obstruction. Conclusion:In the surgical treatment of urinary retention arising from BOO in the first month following renal transplantation, TURP/TUIP yield safe and successful results. In addition, regarding the short and long term outcomes, these procedures may be safely performed with low morbidity.

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Postoperative Voiding Dysfunction in Older Male Renal Transplant Recipients

Cited by 31 publications

References 8 publications

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

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

Cautious Renal Transplantation for the Elderly Is Realistic

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

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