Urological assessment and complications in renal transplantation

Abstract

The native urinary tract is an important consideration in the assessment of patients before renal transplantation. Structural or functional problems that could potentially impact on patient or graft outcome should be identified to allow correction or specific management strategies before transplantation. With careful planning, an abnormal lower urinary tract should not be an exclusion because both supravesical diversion and bladder reconstruction can be successfully employed. Urological malignancy may also need to be considered, particularly with an ageing dialysis population. Again, a past history of cancer may not be an exclusion from consideration. In many instances, both prostate and kidney tumours may be detected as incidental findings at an early stage with little likelihood of impacting on the patient's life expectancy for 10 years or more. In these cases, periods of observation before consideration of transplantation may not be required. Techniques employed in the native urinary tract as part of modern urological practice have reduced the incidence and impact of ureteric complications after transplantation. With routine ureteric stenting and percutaneous accessing of the transplant collecting system, less than 1% of patients require open surgery for urological complications.