Urological evaluation of adult renal transplant recipients

We retrospectively reviewed the charts of 150 consecutive patients who underwent renal transplantation at our institution in 1990 to determine the effectiveness of our pre-transplantation urological evaluation. Of 100 patients who met the inclusion criteria 74 were evaluated solely with a history and physical examination, urinalysis and a urine culture, while the other 26 underwent additional tests because of either a history of urological problems or abnormalities at the initial evaluation. Urological complications occurred in 18 patients. In 10 patients the complications were related to the operation and included postoperative hematuria from bleeding at the site of the ureteral reimplantation, symptomatic lymphocele formation and urinary fistula resulting from necrosis of the distal ureter. These complications could not have been anticipated by the pre-transplant evaluation. Urological complications in the other 8 patients were a febrile urinary tract infection (4), temporary urinary retention (2), hematuria and back pain requiring bilateral native nephrectomy (1), and lower tract obstructive symptoms (1 who eventually required transurethral resection of the prostate 15 months after transplantation). Only 1 of these complications might have been averted with more extensive preoperative testing and in none of these patients did the urological complication compromise allograft function. We conclude that most patients with end stage renal disease require only minimal evaluation before renal transplantation. More extensive evaluation is necessary only in patients with a strong history of urological disease or with abnormalities found during the basic examination.