Urological evaluation before kidney transplantation : recommendations for practice

Candidates for a kidney transplantation must undergo a complete evaluation, including a urological evaluation. This urological assessment should first of all exclude any pathology of the urinary tract likely to contraindicate a transplantation or to evolve under immunosuppression. Moreover, this assessment should evaluate the lower urinary tract that is to receive a kidney graft. It is therefore necessary to detect and possibly treat uro-genital cancers, benign uropathies of the native kidneys or abnormalities of the lower urinary tract. The basic evaluation is rather simple and non-invasive and includes a complete history, general and urogenital physical examination, urinalysis, total serum PSA measurement, urinary tract ultrasound, and uroflowmetry. If necessary, other explorations and testings will be carried out, such as CT scan, MRI, retrograde uretero-pyelography, uretero-renoscopy, cystoscopy, urethro-cystography or urodynamic examination. This article reviews the various pathologies involved, and sets out practical recommendations for explorations to be performed.