Assessment of Bladder Dysfunction in Male Patients with End-Stage Renal Disease Awaiting Kidney Transplant: Role of...

Lower urinary tract symptoms in patients with end-stage renal disease awaiting kidney transplant present unique challenges to clinicians due to altered urinary patterns and reduced bladder function. Here, we examined demographic characteristics, lower urinary tract symptoms questionnaires, and the bladder diary, focusing on evaluating lower urinary tract symptoms.

We prospectively studied 93 male patients with end-stage renal disease awaiting kidney transplant who underwent urodynamic evaluation. Patients completed validated lower urinary tract symptoms questionnaires (International Prostate Symptom Score, Overactive Bladder Symptom Score, and International Consultation on Incontinence Questionnaire) and maintained 3-day bladder diaries. We analyzed correlations among questionnaire scores, diary data, and urodynamic findings.

Patients were assigned to the control group (normal bladder compliance; n = 55) or the experimental group (low-compliance bladder; n = 38). Standard questionnaires showed limited discriminatory ability between control and experimental groups, with International Prostate Symptom Scores of 6 (3-11) versus 6 (4-10), respectively (P = .602). However, bladder diaries showed significant differences for number of voids per day (3 [2-4] vs 1 [0-2]; P < .001) and maximal functional capacity (100 [50-250] mL vs 0 [3-35] mL; P < .001). The experimental group had significantly longer renal replacement therapy duration versus the control group (60.7 [31.2-86.8] vs 23.6 [16-37.3] months; P < .001). In the retrospective posttransplant outcome review of 17 patients (31%) in the control group and 10 patients (26%) in the experimental group, patients with preoperative low-compliance bladder had higher rates of febrile urinary tract infection (10.5% vs 1.8%; P = .047) and overall complications (80% vs 23%; P = .007).

Conventional questionnaires produced limited characterizations of bladder dysfunction in patients with end-stage renal disease. Bladder diaries demonstrated superior discriminatory ability and may serve as effective noninvasive screening tools to identify low-compliance bladder, guiding further evaluation.