Bladder neck contracture and urethral stricture as complications of renal transplantation

From 1963 to July 26, 1974, 211 men underwent renal transplantation at our clinic. Urethral strictures were present prior to the initial transplant in 4 patients (1.8 per cent) and developed in the post-transplant period in 13 patients (6.1 per cent). Postoperative bladder neck contractures occurred in 2 patients (0.9 per cent). Repeated urethral dilations and surgical procedures on the lower urinary tract were generally well tolerated. Infectious problems were the most common secondary complications. No patient or allograft was lost as a direct result of the lower tract obstruction or its treatment. The greatest morbidity occurred in those patients who had a combination of urethral stricture and/or bladder neck contracture, uremia, previous or current immunosuppression and the absence of urine flowing through the urinary tract. This combination occurred most often in the patient who experienced failure of the first allograft and was being prepared for a second or third transplant. To avoid potentially serious urologic complications, male patients should have a repeat lower urinary tract evaluation and definitive correction of existing obstruction before re-transplantation is considered.