Pre-Transplant Urologic Investigation and Treatment of End Stage Renal Disease

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Abstract
Patients (112) with end stage renal disease were investigated. Clinical evaluations included cystoscopy, cystometry, voiding cystography, bilateral retrograde pyelograms, history and physical examination and appropriate serum and urinary studies. Of the 112 patients, 28 (25%) had significant abnormalities of the urinary tracts. Of the 28 patients, 17 had lower tract abnormalities, such as detrusor hyporeflexia, obstructing prostatic hyperplasia and urethral stricture and 11 had upper tract disease, 9 of whom required a pretransplant surgical procedure. Included in the group of 9 patients were those with polycystic kidneys, staghorn calculi, renin related renal hypertension, chronic pyelonephritis and persistent vesicoureteral reflux. None of the azotemic patients had significant morbidity with the timing of the surgical procedures. Apparently, eradication of such conditions in the pretransplant period resulted in a more suitable candidate for renal transplantation. Abnormalities (25%) underscore the need for early urologic evaluation of these patients to ensure their functional capabilities as a recipient.