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

Abstract

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.

The necessity of voiding cystourethrogram for the evaluation of recipient candidates in adult renal transplantation

“…Another cause of PVR is BOO, which develops due to benign prostate hyperplasia (BPH). It should be kept in mind that male kidney transplant candidates over 50 are at a higher risk for BOO [23]. However, surgical treatment before transplantation is not recommended in patients undergoing dialysis.…”

“…Because anuria will persist following the transurethral resection of prostate (TURP), these patients will be at high risk for development of bladder neck contracture in the postoperative period [24]. In addition to the initiation of alpha blockers in patients with severe lower urinary tract symptoms, it was shown that TURP or transurethral incision of the prostate (TUIP) operations can be performed safely in the first month after transplantation [23].…”

Update on the Management of Urological Problems Following Kidney Transplantation

“…It should be known that it is very difficult to predict the incidence of BOO in these patients due to oliguria or anuria resulting from dialysis [36]. Evaluation of the literature concerning the outcomes of TURP in ESRD patients diagnosed with BPH prior to transplantation shows that oliguria or anuria increases the risk of postoperative bladder neck obstruction in these patients [37]. For this reason, in patients who are oliguric or anuric and diagnosed with BPH pretransplantation, it is recommended to perform the operation after transplantation due to the high risk of morbidity [38].…”

“…A risk of surgery that should be avoided during this period is damage to the ureterovesical anastomosis created during transplantation. Therefore, it is recommended that a cystography be performed preoperatively and that the operation be initiated after confirming that there is no DOI: 10.1159/000512885 anastomotic leak [37]. In addition, low-pressure irrigation and complete hemostasis to prevent clot retention during surgery will reduce postoperative morbidity.…”

“…Other than this, postoperative bacteremia can be a significant complication after TURP or TUIP. For this reason, if a ureteral catheter is present, the catheter should be removed before TURP and reinserted postoperatively if necessary [37].…”