Problems concerning the bladder in renal transplantation. Prognosis--replacement possibilities

Area of Science:

• Nephrology
• Urology

Background:

• Lower urinary tract issues are common in patients with end-stage renal disease and can precede or cause chronic kidney failure.
• Pre-transplant assessment of both upper and lower urinary tracts is vital, with pathological findings in up to 25% of cases.

Purpose of the Study:

• To emphasize the importance of comprehensive pre-renal transplant urinary tract evaluation.
• To discuss management strategies for lower urinary tract dysfunction, including supravesical diversion and bladder augmentation based on urodynamic results.

Main Methods:

• Review of existing literature and clinical practices regarding pre-transplant urinary tract assessment.
• Urodynamic testing to evaluate bladder function and capacity.

Main Results:

• Pathological findings in the urinary tract are present in a significant proportion of patients awaiting transplantation.
• Urodynamic results guide decisions on surgical interventions like urinary diversion or bladder augmentation.
• No reliable prognostic factors currently exist to predict bladder pressure response after transplantation.
• Patients with a supravesical urinary diversion at the time of transplantation require lower urinary tract evaluation for potential reversal.

Conclusions:

• Comprehensive pre-transplant evaluation of the lower urinary tract is essential for optimizing kidney transplant outcomes.
• Urodynamic assessment is key for managing bladder dysfunction and determining the need for surgical interventions.
• Kidney transplant survival rates are comparable between patients with a urinary conduit and those with a normal bladder.