Lower Urinary Tract Dysfunction in Renal Transplant Candidates: A Scoping Review of Assessment Methods and...

We performed a scoping review to map the available evidence regarding pre-transplant lower urinary tract dysfunction (LUTD) assessment in adult renal transplant candidates and to summarise reported associations between pre-transplant LUTD and post-transplant urological outcomes.

Electronic databases were searched up to 30th September 2025. Studies were included if they assessed lower urinary tract function prior to kidney transplantation using clinical history, questionnaires or investigations and reported post-transplant urological complications and/or graft outcomes. Risk of bias was assessed using ROBINS-I V2 for comparative studies and QUIPS for prognostic studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively.

A total of 11 studies comprising 4471 patients met the inclusion criteria. Assessment strategies varied considerably across studies, ranging from clinical history alone to validated symptom questionnaires, uroflowmetry and urodynamic testing. Six studies reported urinary tract infection (UTI) outcomes, with most suggesting an increased risk in patients with pre-transplant LUTD. Evidence for acute urinary retention and urosepsis was limited but directionally consistent with higher complication rates. Data on graft survival outcomes were sparse and heterogeneous, with some studies suggesting an association between pre-transplant LUTD and poorer graft survival.

Pre-transplant LUTD appears to be associated with an increased risk of post-transplant urological complications, particularly UTIs. However, the evidence is heterogeneous and largely observational, predominantly derived from retrospective studies, with limited data on graft outcomes. This scoping review highlights marked heterogeneity in pre-transplant LUTD assessment and supports the development of a standardised assessment framework to guide future research and clinical practice.