Postoperative adaptation of urinary bladder to variable volume of urine in the initial period following kidney transplantation

Prevalence of non-neurogenic male lower urinary tract symptoms after kidney transplantation

OBJECTIVE

This review investigates the prevalence of male non-neurogenic lower urinary tract symptoms (LUTS) after renal transplant, as kidney transplantation is a transformative intervention for patients with end-stage renal disease significantly enhancing quality of life that might be diminished by LUTS.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the PubMed and Scopus databases was performed using specific terms. Inclusion criteria considered male kidney transplant recipients, analysing outcomes in English-language studies. Discrepancies were resolved by consultation.

RESULTS

Among 18 studies involving 29 086 recipients, the prevalence of non-neurogenic LUTS ranged from 5.8% to 33.0%. Studies predominantly used the International Prostate Symptom Score for evaluation. Surgical interventions, mostly for benign prostatic obstruction, ranged from 2.5% to 20.0%. Voiding and post-micturition symptoms were under-represented.

CONCLUSION

This review found varied non-neurogenic LUTS prevalence and characteristics in male kidney transplant recipients, emphasising the need for standardised assessments, prospective studies, and improved understanding of LUTS mechanisms. Enhanced knowledge can guide interventions, additionally benefiting recipient quality of life.

Factors associated with low-compliance bladder in end-stage renal disease patients and development of a clinical prediction model for urodynamic evaluation: the DUDi score

OBJECTIVES

To investigate factors associated with low-compliance bladders (LCB) in pretransplant patients with end-stage renal disease (ESRD) and develop a clinical prediction model for urodynamic studies.

METHODS

This study was a prospective cohort study. Patients with ESRD on the renal transplantation waiting list were recruited and underwent the urodynamic study. Demographics data, predictor factors related to the bladder compliance such as underlying disease of the lower urinary tract disease (LUTD), duration of urine < 250 mL/day, type and duration of renal replacement therapy (RRT), urine volume per day and urodynamic study information were collected. Univariable and multivariable logistic regression models were used to assess the independence of explanatory factors, then we developed the clinical prediction model.

RESULTS

One hundred fifty-two patients participated in the study: 94 patients in the normal bladder group and 58 patients in LCB group. Demographic data were not significantly different between the two groups, except diabetes. Cystometric capacity, detrusor pressure, compliance were significantly different. From the univariate analysis, DM status, duration of RRT, and passing < 100 mL of urine per day were related to LCB. We named the prediction model, the DUDi score based on the predictors (Duration of RRT, Urine volume/day, Diabetes). Higher scores predicted a higher risk of low-compliance bladder [P value = 0.464 according to the Hosmer-Lemeshow test, and the AUC was 0.87 (95% CI 0.81-0.92)].

CONCLUSIONS

Our clinical prediction model is easy to use and provides a high predictive value that is appropriate for patients who have no known LUTD to identify low-compliance bladder. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION FOR PROSPECTIVELY REGISTERED TRIALS: This study was approved by the Thai Clinical Trials Registry Committee on 09 February 2021. The TCTR identification number is TCTR20210209006.

Acute Urinary Retention After Kidney Transplant: Effect on Graft Function, Predictive Factors, and Treatment

BACKGROUND

Benign prostatic hyperplasia (BPH) is common in older adults. Although BPH may be asymptomatic in patients with chronic kidney disease (CKD) with low diuresis, the condition may become troublesome when diuresis resumes after transplantation. This study evaluated the effect that developing acute urinary retention (AUR) in first 4 months after kidney transplantation (KT) can have on graft function at 6 months. The study identified predictive factors and analyzed treatment of AUR in these patients.

METHODS

This study retrospectively included 303 men who received KT. Independent samples Student t test was used to compare glomerular filtration rates (GFRs) at 6 months. Logistic regression was applied to identify predictors of AUR.

RESULTS

The study found that 14 patients developed AUR within the first 4 months after KT. This group had lower GFR at 6 months post-KT. Nine patients required transurethral resection of the prostate, and 2 of these patients developed acute graft pyelonephritis following resection. Residual diuresis and recipient age were predictive factors. Recipient age >55 years was a risk factor. Medical therapy of BPH before transplantation was a protective factor.

CONCLUSIONS

Developing AUR in the first 4 months after KT was associated with lower graft GFR at 6 months, and transurethral resection of the prostate was required in 64% of these patients, with good results. Medical therapy for BPH before the transplant was associated with a lower risk of AUR. Older patients and patients with pretransplant low urine output had a higher risk of AUR. These patients should be closely monitored in the posttransplant period for the presence of obstructive uropathy.

[LOWER URINARY TRACT SYMPTOMS AND FUNCTIONS AFTER RENAL TRANSPLANTATION AT OUR HOSPITAL]

OBJECTIVE

We investigated lower urinary tract symptoms (LUTS) and function in patients who had undergone renal transplantation (RTx).

METHODS

Fifty patients (34 males and 16 females; age 16-68 years) undergoing RTx at our hospital were included in this study. Average follow-up after RTx was 6.1 years (range 0.5-28). The pre-transplant dialysis period averaged 2.5 years (range preemptive-18.6 years). We conducted the evaluation of lower urinary tract symptoms (LUTS) and function using uroflowmetry (UFM) , residual urine measurement, 24h bladder diary, International Prostate Symptom Score (IPSS), QOL score, Overactive Bladder Symptom Score (OABSS) and Core Lower Urinary Tract Symptom Score (CLSS).

RESULTS

Average first desire to void and maximum desire to void were 89.9 mL and 185 mL respectively in cystometry before RTx. Atrophy of the bladder before RTx showed a correlation with the dialysis period. UFM of post-RTx was maximum urinary flow rate of 21.8 mL/s and a voided volume of 287.6 mL. Severe cases of IPSS, QOL, OABSS and CLSS were not observed. Average 24h voided volume, urination times and nocturia were 2,329 mL, 8.2 times and 0.9 times respectively. Polyuria after RTx was observed in 21 patients (42%). Aging and vascular lesions such as diabetes and cardiovascular disease were the most important factor of LUTS.

CONCLUSIONS

After RTx, LUTS were present in a number of cases after RTx. Patients undergoing RTx has been aging, it is considered necessary to perform the evaluation of LUTS before RTx.

Transurethral incision of the bladder neck in a woman with primary bladder neck obstruction after kidney transplantation

Voiding dysfunction is frequently seen in the early posttransplant period. Among other causes, this condition can arise due to bladder outlet obstruction. Primary bladder neck obstruction (PBNO) is a possible but very rare cause of bladder outlet obstruction. We present the case of a 52-year-old woman who, after kidney transplantation, presented with PBNO. The diagnosis was established based on symptoms, uroflowmetry, and multichannel urodynamics with electromyography. The transurethral incision of the bladder neck was made at the 5- and 7-o'clock position. After the operation, the maximal flow rate was significantly increased, and postvoid residual urine was decreased compared to the preoperative findings. The patient was followed for 5 years, and her voiding improvement is persistent. This is the first reported case of PBNO treated with a transurethral incision of the bladder neck in a posttransplantation female patient.

Bladder dysfunction following renal transplantation is it predictable?

Dysfunction of the urinary bladder is often faced in kidney transplantation due to various structural, neurological, infectious, or other pathologies. As the goal is to obtain a well functioning urinary bladder or at least, a low-pressure reservoir without reflux, specific urologic examinations and therapies should be performed. This review based on a Medline and PubMed search as well as on international guidelines and personal experience, reflects the actual knowledge in the field of pretransplant urologic evaluation as well as pre- and posttransplant optimal therapeutic options. The evaluation of these factors and interventional strategies will help to improve long-term transplant outcomes.

Bladder function of end-stage renal disease patients

OBJECTIVES

To evaluate the bladder function of end-stage renal disease (ESRD) patients by using video H(2)O cystometry (CM) before renal transplantation (RTx).

METHODS

A total of 92 patients (57 men and 35 women; mean age 45.4 years; mean period of renal replacement therapy (RRT) 60.2 months) were divided in two groups based on the presence of detrusor overactivity (DO). In each group the following parameters were recorded during CM: first sensation (FS), maximum cystometric capacity (MC) and compliance. The effect of the duration of RRT on the H(2)O cystometric results was also assessed.

RESULTS

There were 25 patients (27.2%) who had DO before their operation, this ratio being higher than the general Japanese population. Subjects with DO were observed independently for the duration of RRT and there was no difference in the prevalence of DO based on this variable. In contrast, 50 patients kept their bladder compliance in the normal range. The numerical value of FS, MC and compliance decreased proportionally for the duration of RRT.

CONCLUSIONS

Patients undergoing RTx frequently present with bladder dysfunction in terms of low capacity, low compliance and also DO. This bladder dysfunction has a negative impact on patients' quality of life. Thus, bladder function and its related symptoms require specific attention during the management of transplant patients.

Evaluation of video-urodynamic studies before renal transplantation in chronic renal failure patients

OBJECTIVES

To evaluate the role of video-urodynamic examination prior to renal transplantation.

METHODS

Sixty-four kidney transplant recipients were included into the study. All patients underwent video-urodynamic examination and separate uroflowmetry. Results were evaluated based on daily mean amount of urine, duration of chronic renal failure and presence of diabetes mellitus.

RESULTS

Thirty-five (54.6%) patients showed video-urodynamic abnormalities. The mean detrusor capacity was 234 ml, the mean detrusor compliance was 17.5 cm H(2)O/ml, the mean maximum detrusor pressure was 61.9 cm H(2)O and the mean Q (max) was 13.8 ml/s in all patients. Vesicoureteral reflux was detected in 15 (23%) patients. The mean detrusor compliance and detrusor capacity significantly decreased as the daily amount of urine decreased and as the duration of chronic renal failure increased. Also, there was no significant relation between presence of diabetes mellitus and detrusor capacity and detrusor compliance.

CONCLUSION

Video-urodynamic studies before renal transplantation provide earlier diagnosis of lower tract abnormalities, which are likely to cause graft dysfunction.

Frequency and nocturia after successful renal transplantation: a normal situation?

OBJECTIVE

To analyse lower urinary tract function before and after successful renal transplantation and compare the data with those from a healthy control group.

PATIENTS AND METHODS

Data were gathered by retrospective analysis of 331 charts of patients transplanted between March 1998 and May 2003, using written questionnaires and personal interview, and investigation of 150 patients. The control group consisted of 150 urologically healthy volunteers.

RESULTS

Frequency and nocturia were the main lower urinary tract symptoms. Frequency of more than six voids/day was reported by 87% and nocturia of more then one void/night by 93% of all patients after successful renal transplantation. There was no significant correlation with fluid intake, diuretic medication, gender or age. Over the years the number of voids tended to decrease but remained higher than in the control group. However, 94% of all patients were happy with the quality of life after renal transplantation.

CONCLUSION

Frequency and nocturia are the two main characteristics of lower urinary tract function after renal transplantation, probably through a combination of high fluid intake, a long-term defunctionalized urinary bladder during renal replacement therapy, a denervated donor kidney, concomitant diseases and psychosocial distress. Quality of and satisfaction with life were not compromised.