Abstract
Urological evaluation is an essential component of the pre-transplantation assessment of any potential renal recipient. The main objective is to identify structural and functional abnormalities of the native urinary tract that may preclude transplantation or threaten patient or graft survival. Mainly the assessment should be tailored to determine the need for pre transplant nephrectomy and the suitability of the lower urinary tract to receive the graft. Meticulous measures taken to harvest a healthy ureter which is properly implanted with a non refluxing method is mandatory since ureteric complications could arise at any time and could be an unforgiving threat to the graft viability or even patient survival. These post operative complications are now increasingly managed by endourological or percutaneous image guided techniques which have become a part and parcel of modern urological practice. As a result, reoperation is rarely required unless all other resources have been exhausted. Hence the true incidence of technical graft loss due to urological complications is infrequent.
Highlights
Urological evaluation is an essential component of the pre-transplantation assessment of any potential renal recipient
The most frequent pre-transplant surgical consideration of the upper tracts of the renal system is the need of nephrectomy with or without ureterectomy
As Lap-donor nephrectomy is considered as an advanced technique which should be practised towards the end of the learning curve of a laparoscopist, presence of an experienced general or preferably a urological surgeon could minimize complications during organ harvesting [3]
Summary
The most frequent pre-transplant surgical consideration of the upper tracts of the renal system is the need of nephrectomy with or without ureterectomy. As Lap-donor nephrectomy is considered as an advanced technique which should be practised towards the end of the learning curve of a laparoscopist, presence of an experienced general or preferably a urological surgeon could minimize complications during organ harvesting [3]. High grade vesicoureteric reflux (VUR) that is left untreated post transplantation is associated with increased urinary tract infections, even when urinary tract infections were not a problem prior to transplantation [4]. Ureterectomy is indicated in the presence of VUR grade III or above or presence of primary renal infections due any degree of reflux disease. Dilated donor ureters could be used for bladder augmentation in children prior to transplantation
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