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

Article (PDF Available)inInternational Journal of Urology 16(4):388-92 · March 2009with17 Reads
DOI: 10.1111/j.1442-2042.2009.02252.x · Source: PubMed
Abstract
To investigate lower urinary tract symptoms (LUTS) and their impact on quality of life (QOL) in patients having undergone renal transplantation (RTX). 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. 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. 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.
Original Article: Clinical Investigation
Lower urinary tract symptoms and their impact on quality of life
after successful renal transplantation
Takahiko Mitsui, Naohiko Shimoda, Ken Morita, Hiroshi Tanaka, Kimihiko Moriya and Katsuya Nonomura
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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), respec-
tively. 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 noctur nal polyuria, which
affected nocturia in IPSS as well as sleep/energy disturbances in KHQ compared with patients without noctur nal 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.
Key words: lower urinary tract function, lower urinary tract symptoms, nocturnal polyuria, renal transplantation, quality of life.
Introduction
Renal transplantation (RTX) is broadly accepted as an optimum treat-
ment for end-stage renal disease (ESRD). Long-term allograft survival
is continuously improved through recent developments of immunosup-
pressive therapies. However, the demand for kidney donors is much
larger than the supply in Japan. Although some patients can take pre-
emptive or early RTX with benefits of a related living kidney donor or
cadaveric kidney donor, most patients require renal replacement thera-
pies, such as hemodialysis or peritoneal dialysis, and the average
waiting period for renal graft is around 4 years in Japan. During the
waiting period for renal graft, most patients with ESRD become auria
and do not use the lower urinary tract (LUT), which may lead to
degeneration and dysfunction of the LUT. Actually, there is an inci-
dence of urodynamic abnormalities in ESRD.
1–3
After successful RTX, urine production is immediately restored and
the LUT needs to adapt to variable urine volumes after RTX. Although
the adaptation of the LUT usually occurs within 6 m onths after RTX,
4
some studies have revealed that LUT dysfunction and LUT symptoms
might persist long-term.
5–7
Meanwhile, patients with RTX are
instructed to take ample amounts of fluid , especially during the early
periods after RTX, because of preservation of renal function. However,
LUT function and LUT symptoms have had little attention after RTX to
date. In the present study, we investigated LUT function and symptoms
in patients with RTX, which could be implicated in quality of life
(QOL) after RTX.
Methods
LUT function and symptoms were assessed in 43 patients (25 males
and 18 females) who underwent RTX at Hokkaido University Hospital
and had follow-up for 6 months and more after RTX. The median age
was 47 years (20–68 years) and the follow-up period after RTX was
from 6 to 184 months (a median: 41 months). A median serum creati-
nine level in the most recent visit was 1.3 mg/dL (0.7–3.7). Original
diseases for ESRD were chronic glomerulonephritis in 27 (63%), neph-
rotic syndrome in three (7%), diabetic nephropathy in three (7%),
reflux nephropathy in two (5%) and others in eight (18%). Pre-
transplant dialysis had been carried out in 38 patients (88%) with a
median duration of 4.1 years (1 month–31 years)
The methods of urodynamics referred to documents of the Interna-
tional Continence Society
8
and micturition function was assessed by
uroflowmetry (UFM) and postvoid residual urine volume (PVR).
Voiding dysfunction was defined as follows; less than 5% of a
maximum flow rate in Liverpool nomogram,
9
abnormal flow patterns
such as obstructive, strain, and intermittent, or more than 50 mL of
PVR. To assess behavior of micturition and fluid intake, a 24-h bladder
diary for 3 days was carried out. To analyze LUT symptoms and QOL,
we used the Inter national Prostate Symptom Score (IPSS), QOL score
and King’s Health Questionnaire (KHQ).
10
The IPSS is a set of seven
questions regarding incomplete emptying, micturition frequency, inter-
mittence, urgency episodes, weak urinary stream, straining at urina-
tion, and nocturia. An eighth question for the QOL score, termed the
‘bother score’, pertains to the patients’ perceived QOL relating to LUT
symptoms. KHQ consists of 21 questions divided into nine domains.
The domains are general health perception (KHQ-1), impact (KHQ-2),
role limitations (KHQ-3), physical limitations (KHQ-4), social limita-
tions (KHQ-5), personal relationships (KHQ-6), emotions (KHQ-7),
and sleep/energy (KHQ-8), and severity of urinary symptoms (KHQ-
9). The instrument contains a separate severity/coping
Correspondence: Takahiko Mitsui MD PhD, Department of Urology, Hok-
kaido University Graduate School of Medicine, North-15, West-7, Kita-ku,
Sapporo 060-8638, Japan. E-mail: mitsui68@med.hokudai.ac.jp
Received 8 October 2008; accepted 10 December 2008.
Online publication 4 February 2009
International Journal of Urology (2009) 16, 388–392 doi: 10.1111/j.1442-2042.2009.02252.x
388 © 2009 The Japanese Urological Association
measure index. A scoring system of each domain, which is available
from the authors, is carried out to produce a range of scores from 0 to
100, in which 0 represents the best possible health status and 100
represents the worst.
10
Statistical analysis was car ried out using Student’s t-test and Fisher’s
exact test. A P-value of less than 0.05 was considered significant.
Results
Bladder diar y
Data from the 24-h bladder diary are summarized in Table 1. A 3-day
voiding diary was kept in 39 patients. A mean of the daily fluid intake
volume and daily urine output volume was 2136 mL and 2446 mL,
respectively, and 23 patients (59%) of 39 took more than 2000 mL of
fluid for 24 h. A mean of daily micturition frequency and nocturia was
8.7 times per day and 1.2 times per sleep, respectively, and the mean
nocturnal urine production was 32.2%. Ten patients (26%) of 39 woke
up more than twice for voiding during sleeping.
Micturition function
Voiding dysfunction assessed by UFM and PVR was observed in 12
(28%) of 43 patients, which consisted of six males and six females.
Original diseases in patients with voiding dysfunction were chronic
gromerulonephritis in four, nephrotic syndrome in three, diabetic neph-
ropathy in two, reflux nephropathy in one and others in two. A repre-
sentative case is shown in Figure 1. UFM revealed that flow pattern was
flattened and a maximum flow rate less than the fifth percentile referred
to the Liverpool nomogram. Since PVR was also more than 50 mL, this
patient was diagnosed to have voiding dysfunction.
Results of micturition function are summarized in Table 2 and
Figure 2A. Age, periods of dialysis, time after RTX and serum creati-
nine level in patients with voiding dysfunction were not different com-
pared with patients without voiding dysfunction (Table 2). Total IPSS
score was significantly higher in patients with voiding dysfunction
(P < 0.05), although there was no difference in QOL score. Each
domain of KHQ was not affected by voiding dysfunction (Fig. 2A).
Polyuria
Polyuria was defined as the measures production of more than
40 mL/kg of urine in 24 h,
11
and 19 (49%) of 39 patients had polyuria
(eight males and 11 females). The results of polyuria were summa-
rized in Table 3 and Figure 1B. Age, periods of dialysis, time after
RTX and serum creatinine level in patients with polyuria were not
different compared with patients without polyuria. Five patients (26%)
with polyuria had voiding dysfunction, while four patients (20%)
without polyuria also had voiding dysfunction, which was not statis-
tically significant. Regarding IPSS and QOL score, there was no sta-
tistical difference in the scores including domain of frequency in IPSS
between patients with and without polyuria. In the data of the 24-h
voiding diary, daily fluid intake was significantly higher in patients
with polyuria (P < 0.01), and there was a trend that micturition fre-
quency was higher in patients with polyuria (P = 0.07). Polyuria was
not implicated in nocturia. Each domain of KHQ was not affected by
polyuria (Fig. 2B).
Nocturnal polyuria
Nocturnal urine volume was the total volume of urine passed between
the time when the individual goes to bed with the intention of sleeping
and time of waking with the intention of rising, which excludes the last
void before going to bed but includes the first void after rising in the
morning.
8
Nocturnal polyuria was defined as an output of nocturnal urine
volume greater than 35% of the 24-h urine volume,
12
and 20 (51%) of
39 patients had nocturnal polyuiria (10 males and nine females).
Results of nocturnal polyuria are summarized in Table 4 and Figure 1C.
In patients with nocturnal polyuria, age was higher and periods of
dialysis were longer compared with patients without nocturnal poly-
uria, although time after RTX and serum creatinine level were not
significantly different between the groups. Regarding micturition func-
tion, eight patients (40%) with nocturnal polyuria had voiding dysfunc-
tion, while three patients (15%) without polyuria had voiding
dysfunction, which was not statistically significant. The domain of
nocturia (P < 0.05), total score (P = 0.08) in IPSS and QOL score
(P = 0.06) was higher in the nocturnal polyuria group. The voiding
diary showed that nocturia was observed more in patients with noctur-
nal polyuria, although there was no significant difference in daily
micturition frequency and daily fluid intake. Domain of sleep/energy in
KHQ was significantly higher in patients with nocturnal polyuria
(P < 0.01) (Fig. 2C).
Discussion
The present study investigated LUT function, LUT symptoms, and
QOL regarding LUT function in patients with RTX. Twelve (28%) of
43 patients had voiding dysfunction assessed by UFM and PVR.
Voiding dysfunction deteriorated LUT symptoms, but not QOL.
Table 1 Results of the 24-h voiding diar y
Mean
(1) Daily water intake 2135.7 mL/day (1150–3430 mL)
(2) Daily voided volume 2446.3 mL/day (1336–4733 mL)
(3) Daily micturition frequency 8.7 times/day (3–18)
(4) Nocturia 1.2 times/asleep (0–4)
(5) Nocturnal urine production 32.2% (12.2–54.3)
50 mL/s Flow Rate
01020
v.v. 373 mL
12.2 mL/s
7.2 mL/s
73 mL
Qmax
Qave
PVR
30 40 50
Fig. 1 Representative case of a 46-year-old male. The original disease was
nephritic syndrome, the period of dialysis was 9 months and the time after
renal transplantation (RTX) was 183 months. Uroflowmetry (UFM) UFM
revealed that flow pattern was flattened and a maximum flow rate less than
the fifth percentile referred to the Liverpool nomogram. Postvoid residual
urine volume (PVR) was also more than 50 mL. Thus, this patient was diag-
nosed to have voiding dysfunction.
LUT symptoms and function after RTX
© 2009 The Japanese Urological Association 389
Polyuria implicated in fluid intake was observed in 19 patients (49%),
which did not affect LUT symptoms or QOL. Meanwhile, 20 (51%)
had nocturnal polyuiria, which led to nocturia and lowered QOL. Thus,
we should focus more on LUT function and symptoms in RTX patients
and conduct appropriate treatments for them.
It remains controversial which questionnaires should be used to
evaluate QOL concerning LUT function in RTX patients, because RTX
patients may be considered different from patients with LUT symptoms
and no questionnaires have been validated to evaluate urination-related
QOL in RTX patients. In fact, RTX patients are educated to take care
of fluid intake and they may enjoy a life without need for renal replace-
ment therapy. KHQ is useful to assess the detailed urination-related
QOL status of men and women with LUTS,
13
while KHQ was origi-
nally designed and has been recommended as a disease-specific QOL
questionnaire for female urinary incontinence. Hence, we used QOL
score and KHQ to evaluate urination-related QOL in the present study,
although they might be limited to reflect urination-related QOL in RTX
patients.
Voiding dysfunction assessed by UFM and PVR in RTX patients was
common in the present study, and it affected LUT symptoms in IPSS.
During the dialysis period , most patients with ESRD do not sustain
diuresis and become oligouria, which leads to bladder inactivity and
atrophic changes in the bladder walls. After successful RTX, adaptation
of the bladder occurs and urodynamic parameters such as maximum
flow rate, bladder capacity and bladder compliance reach to the plateau
within 6 months after RTX.
4
In the present study, although micturition
function was assessed at 6 months and more after RTX, voiding dys-
function presented in 28%, which was not related to age, periods of
dialysis, time after RTX, polyuria, or nocturnal polyuria. Voiding dys-
function after RTX may be implicated in original disease for ESRD.
Actually, according to original diseases for ESRD, voiding dysfunction
was frequently observed in nephrotic syndrome (three patients, 100%),
diabetic nephropathy (two patients, 67%), reflux nephropathy (one
patient, 50%), while the rate of voiding dysfunction was relatively
lower in chronic gromerulonephritis (four patients, 15%) in the present
study. Since the prevalence of voiding dysfunction in our present study
is small, we cannot identify which original diseases are risk factors for
voiding dysfunction after RTX. However, it is reported that 86% of
patients with ESRD due to diabetic nephropathy have urodynamic
abnormality
1
and urodynamic abnor malities were also observed in
ESRD due to other diseases.
2,3
Further study is necessary to evaluate
the impact of original diseases of ESRD for micturition function.
According to the questionnaire for LUT symptoms and QOL,
patients with voiding dysfunction complained of LUT symptoms with
higher total IPSS scores, while voiding dysfunction did not affect QOL
by the QOL score and KHQ in the present study. This result may imply
that patients with RTX are free from renal replacement therapy and
they perceive changes of LUT symptoms as positive. Meanwhile,
voiding dysfunction has the potential to increase the susceptibility of
urinary tract infection, which affects renal graft function and mortality
in patients with RTX.
14,15
Thus, we should conduct appropriate man-
agement for micturition function to treat LUT symptoms and prevent
urinary tract infection during follow-up after RTX, even if treatments of
voiding dysfunction may not affect patients’ QOL.
Table 2 Micturition function and quality of life (QOL)
Voiding dysfunction P-value
-+
Age (years) 44.4 12.4 43.8 12.1 n.s.
Dialysis (years) 7.5 8.1 5.2 9.0 n.s.
Time after RTX (Months) 70.0 58.1 58.3 68.3 n.s.
s-Cre (mg/dL) 1.3 0.4 1.6 0.8 n.s.
IPSS (total) 4.9 5.6 8.4 5.1 <0.05
QOL score 1.2 1.4 1.9 1.2 n.s.
Daily urine volume 2148 596 2101 477 n.s.
Nocturnal urine volume 799 398 823 385 n.s.
IPSS, International Prostate Symptom Score; n.s., not significant; RTX, renal transplantation; s-Cre, serum creatinine level.
35(a)
Voiding dysfunction ()
Voiding dysfunction (+)
30
25
20
15
10
5
0
KHQ-1
KHQ score
KHQ-2 KHQ-3 KHQ-4 KHQ-5 KHQ-6 KHQ-7 KHQ-8 KHQ-9
Polyuria (–)
Polyuria (+)
(b)
KHQ score
KHQ-1 KHQ-2 KHQ-3 KHQ-4 KHQ-5 KHQ-6 KHQ-7 KHQ-8 KHQ-9
35
30
25
20
15
10
5
0
Nocturnal polyuria (–)
Nocturnal polyuria (+)
*P < 0.01
(c)
KHQ score
KHQ-1 KHQ-2 KHQ-3 KHQ-4 KHQ-5 KHQ-6 KHQ-7 KHQ-8 KHQ-9
35
30
25
20
15
10
5
0
Fig. 2 Results of King’s Health Questionnaire (KHQ) for micturition func-
tion (a), polyuria (b), and nocturnal polyuria (c). (a) Each domain of KHQ was
not affected by voiding dysfunction. (b) Each domain of KHQ was not
affected by polyuria. (c) Domain of sleep/energy in KHQ was significantly
higher in patients with nocturnal polyuria (P < 0.01).
T MITSUI ET AL.
390 © 2009 The Japanese Urological Association
In daily urine output volume, almost a half of RTX patients in the
present study had polyuria, which was defined as the measured pro-
duction of more than 40 mL/kg of urine in 24 h.
11
Bladder diary
revealed that daily fluid intake was significantly higher (P < 0.01),
and the number of voids was more in patients with polyuria
(P = 0.07). Previously reported data also revealed that urinary fre-
quency occurred after RTX and persisted even in the third year after
RTX, while these data did not show a correlation to fluid intake.
5–7
In
the present study, there was correlation that much daily fluid intake
induced frequent voids caused by polyuria in the bladder diary, which
was not implicated in age, periods of dialysis, time after RTX or
serum creatinine level. Although patients with RTX seem to take
much fluid to preserve renal function, it is doubtful whether they need
more than 2000 mL per day of fluid even when in a stable condition
after RTX. We need to consider again how much fluid is appropriate
for preservation of renal function, but which does not induce urinary
frequency. However, patients with polyuria were fortunately not dis-
turbed in QOL so far, which is compatible with previously reported
data.
7
This may be because patients with RTX are educated to take
fluids for renal function, and they enjoy a life after RTX compared
with a life with renal replacement therapy.
More than a half of RTX patients had nocturnal polyuiria, which was
defined in the present study as an output of noctur nal urine volume
greater than 35% of 24-h urine volume,
12
and nocturnal polyuria
induced nocturia. Nocturnal polyuria generally may be secondary to
congestive heart failure, diabetes mellitus, obstr uctive sleep apnea,
peripheral edema, or lifestyle patterns such as night-time drinking, and
then the nocturnal fraction of daily urine output increases with increas-
ing age.
16
Interestingly, although there was no difference between noc-
turnal polyuria and daily fluid intake, which were compatible with
previously reported data,
5–7
age was higher and periods of dialysis were
longer in patients with nocturnal polyuria. Regarding age, nocturia
caused by nocturnal polyuria is generally a common complaint in the
elderly, because day to night ratios of urinary excretion gradually
reduce with age, which may be implicated in cardiac function, hor-
monal changes such as arginine vasopressin secretion and so on.
17–19
Hypertension, which is common in elderly patients, is also related to
increasing nocturnal diuresis.
18,19
Meanwhile, in periods of dialysis
Table 3 Polyuria and quality of life (QOL)
Polyuria P-value
-+
Age (years) 45.7 13.1 45.8 9.0 n.s.
Dialysis (years) 5.9 5.9 9.4 10.5 n.s.
Time after RTX (months) 84.3 60.7 56.7 62.3 n.s.
s-Cre (mg/dL) 1.5 0.7 1.3 0.5 n.s.
Voiding dysfunction 20% 26% n.s.
IPSS (total) 5.9 5.9 6.3 5.6 n.s.
IPSS (Ffrequency) 1.2 1.6 1.5 0.9 n.s.
QOL score 1.9 1.2 1.2 1.4 n.s.
Micturition frequency 7.9 2.9 9.5 2.5 0.07
Nocturia 1.1 1.0 1.3 1.2 n.s.
Daily fluid intake 1808.4 360.7 2463.0 539.8 <0.01
IPSS, International Prostate Symptom Score; n.s., not significant; RTX, renal transplantation; s-Cre, serum creatinine level.
Table 4 Nocturnal polyuria and quality of life (QOL)
Nocturnal polyuria P-value
-+
Age (years) 42.2 12.6 49.2 8.6 <0.05
Dialysis (years) 4.7 5.8 10.3 9.8 <0.05
Time after RTX (months) 74.2 61.7 67.3 64.2 n.s.
s-Cre (mg/dL) 1.3 0.4 1.4 0.8 n.s.
Voiding dysfunction 15% 40% n.s.
IPSS (total) 5.0 5.3 7.6 6.2 0.08
IPSS (nocturia) 0.7 0.8 1.7 0.9 <0.05
QOL score 1.5 1.7 1.9 1.2 0.06
Micturition frequency 8.6 2.9 8.5 2.7 n.s.
Nocturia 0.4 0.6 1.7 1.1 <0.01
Daily fluid intake 2109.4 618.2 2151.3 488.1 n.s.
IPSS, International Prostate Symptom Score; n.s., not significant; RTX, renal transplantation; s-Cre, serum creatinine level.
LUT symptoms and function after RTX
© 2009 The Japanese Urological Association 391
before RTX, autonomic dysfunction, which patients with uremia
receiving dialysis commonly have,
20
may be implicated in nocturnal
polyuria. Thus, age and periods of dialysis before RTX could affect
nocturnal polyuria after RTX.
Although previously reported data also revealed that nocturia was
frequently observed after RTX and it persisted even at the third year
after RTX,
5–7
it does not compromise QOL after RTX.
7
In the present
study, however, more than a half of patients with RTX had nocturnal
polyuria that caused nocturia after RTX, and nocturnal polyuria
affected QOL, especially the domain of sleep/energy in KHQ. So, we
need to consider that treatments of nocturnal polyuria in RTX patients.
Patients with nocturnal polyuria generally have tried changes of
lifestyle including restricting fluid intake at night and take pharmaco-
logical therapy using desmopressin, a synthetic analog of arginine
vasopressin, and diuretic medication. In addition, we should consider
again whether control of blood pressure is appropriate for patients with
nocturnal polyuria, too. These treatments can be effective even for RTX
patients with nocturnal polyuria. Thus, we should star t treatments of
nocturnal polyuria in RTX patients to make nocturia reduced and their
QOL superior to a current state.
Conclusions
The present study demonstrated that patients with RTX frequently had
voiding dysfunction and nocturia basically caused by nocturnal poly-
uria. Voiding dysfunction led to complaints of LUT symptoms and
nocturnal polyuria affected QOL in RTX patients. Thus, we should
focus more on LUT function and symptoms in patients with RTX and
conduct appropriate treatments for them.
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392 © 2009 The Japanese Urological Association
  • Article · Jan 2011
  • [Show abstract] [Hide abstract] ABSTRACT: Dysfunction of the urinary bladder is often faced in kidney transplantation due to various structural, neurological, infectious, or other pathologies. As the goal is to obtain a well functioning urinary bladder or at least, a low-pressure reservoir without reflux, specific urologic examinations and therapies should be performed. This review based on a Medline and PubMed search as well as on international guidelines and personal experience, reflects the actual knowledge in the field of pretransplant urologic evaluation as well as pre- and posttransplant optimal therapeutic options. The evaluation of these factors and interventional strategies will help to improve long-term transplant outcomes.
    Article · Feb 2011
  • [Show abstract] [Hide abstract] ABSTRACT: Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in the renal transplant process and provide a unique opportunity to the trainees of that particular program. For renal transplant recipients, preoperative evaluation of voiding dysfunction and other genitourinary anomalies might be necessary before the transplant. Also, occasional surgical intervention to prepare a patient for renal transplant might be necessary, such as in a patient with a small renal mass that is detected by a screening pretransplant ultrasound. Intraoperatively, for patients with complex urological reconstructions that might be related to the etiology of the renal failure (urinary diversion, bladder augmentation), a urologist who is familiar with the anatomy should be available. Postoperatively, urological evaluation and intervention might be necessary for patients who had a pre-existing urological condition or who might have developed something de novo after the transplant. Although renal transplant programs could consult an on-call urologist for particular issues on an as-needed basis, having a urologist, who has repeated exposure to the particular issues and procedures that are involved with renal transplantation, and who is part of a dedicated multidisciplinary renal transplant team, provides optimal quality of care to these complex patients.
    Full-text · Article · Mar 2011
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