Bladder Outflow Obstruction Research Articles

Treatment validation of the Solomon-Greenwell nomogram for female bladder outlet obstruction.

Bladder outflow in women (bladder outlet obstruction [BOO]) has no well-accepted defining diagnostic criteria. Various nomograms exist based on flow rates, pressure-flow data, and fluoroscopy. We have prospectively evaluated the Solomon-Greenwell bladder outflow obstruction nomogram (SG BOO nomogram) as a measurement of BOO resolution following targeted surgical intervention. The routine posttreatment urodynamics of 21 unselected women with an original urodynamic diagnosis of BOO on fluoroscopy and the SG BOO nomogram (BOO boundary defined as Qmax > 2.2 Pdet.Qmax + 5) were reviewed. All women had symptomatic BOO secondary to anterior pelvic organ prolapse (aPOP), urethrovaginal fistula (UVF), previous stress urinary incontinence (SUI) surgery, urethral stricture (US), or urethral diverticulum (U Div). Following treatment, all presenting symptoms resolved and simple urodynamics were performed as part of routine follow-up. The urodynamic findings preoperatively and postoperatively showed statistically significant changes posttreatment in mean flow rate which increased from 9.38 to 14.71 mL/s, mean Pdet.Qmax which decreased from 38 to 18.38 cmH2 O, and mean SG BOO nomogram probability (PBOO) which reduced from PBOO = 0.68 to 0.08. Mean SG BOO nomogram PBOO was significantly reduced posttreatment in all individual categories except UVF where a nonsignificant reduction from PBOO = 0.55 to 0.05 occurred. All urodynamic parameters significantly improve in women who become asymptomatic following surgical treatment of BOO. This improvement is best demonstrated by the change in probability of BOO according to the Solomon-Greenwell nomogram. These findings underline the validity of the Solomon-Greenwell female BOO nomogram for diagnosing and monitoring BOO in women.

"In-bore" MRI prostate biopsy is a safe preoperative clinical tool to exclude significant prostate cancer in symptomatic patients with benign prostatic obstruction before transurethral laser enucleation.

Purpose of our study was to investigate the role of a negative in-bore MRI-guided biopsy (MRI-GB) in comparison to a negative multiparametric prostate MRI (mpMRI) and a contextual negative transrectal ultrasound guided biopsy of the prostate with regard to incidental prostate cancer findings in the surgical specimen of men who underwent to Holmium Laser enucleation of prostate (HoLEP) with a preoperative suspicion of prostate cancer. Data of 117 of symptomatic patients for bladder outflow obstruction who subsequently underwent to HoLEP was retrospectively analyzed form a multicentric database. All patients had a raised serum PSA and/or an abnormal digital rectal examination (DRE) with a pre-interventional mpMRI. Prostate cancer was excluded either with an en-bore MRI-GB (group "IN-BORE MRI-GB" n = 57) in case of a suspect area at the mpMRI or with a standard biopsy (group "mpMRI + TRUS-GB" n = 60) in case of a negative mpMRI. Preoperative characteristic surgical and histological outcomes were analyzed. Univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Both groups presented moderate to severe lower tract urinary symptoms: median IPSS was 19 (IQR: 17.0-22.0) in the IN-BORE MRI-GB group and 20 (IQR: 17.5-22.0) in the mpMRI + TRUS-GB (p = 0.71). No statistically significant difference was found between the two groups besides total prostate volume with 68 cc (IQR: 58.0-97.0) in the IN-BORE MRI-GB group and 84 cc (IQR: 70.0-115.0) in the mpMRI + TRU-GB group (p = 0.01) No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. No different rates (p = 0.50) of iPCa were found in the IN-BORE MRI-GB group (14%) in comparison with mpMRI + TRUS-GB group (10 %); pT stage and ISUP Grade Group in iPCa stratification were comparable between the two groups. In multivariate analysis a statistically significant correlation with age as an independent predictive factor of iPCa was found (OR 1.14; 95% CI: 1.02-1.27; p = 0.02) while no correlations were revealed with PSA (OR 1.12; 95% CI: 0.99-1.28; p = 0.08) and a negative in-bore MRI-GB (OR 1.72; 95% CI: 0.51-5.77; p = 0.37). Including a mpMRI and an eventual in-bore MRIGB represents a novel clinical approach before surgery in patients with symptomatic obstruction with a concomitant suspicion of PCa, leading to low rate of iPCa and avoiding unnecessary standard TRUS-GB biopsies.

The First 48 Consecutive Patients with 3-Year Symptom Score Follow-Up Post-Prostate Artery Embolization (PAE) at a Single-Centre University Hospital.

Few studies on prostate artery embolization (PAE) follow patients up after 12months. We aimed to evaluate the symptomatic efficacy of PAE in our patient cohort at 3years. A total of 48 consecutive patients undergoing PAE from June 2012 to August 2014 were included in this retrospective study. All patients underwent formal urodynamics to confirm bladder outflow obstruction prior to PAE. International Prostate Symptom Score (IPSS) was performed at baseline, 3months, 12months and 3years post-PAE. Mean patient age was 65.6 ± 7.4, prostate volume 99.1 ± 56.6cm3, IPSS 23.5 ± 6.0, quality-of-life score 4.6 ± 0.9, Qmax 8.4 ± 2.8ml/s, post-void residual volume 185.8 ± 55.6ml. Technical success (bilateral embolization) was achieved in 43 out of 48 cases (89.6%). 11/39 bilateral PAE patients completing follow-up (2 died, 2 lostto follow-up) underwent surgery, indicating a 71.8% clinical success rate at 3 years. No significant change was demonstrated in IPSS or QOL between 1 and 3years for patients free from surgical intervention (IPSS 8.3 vs 10.0, p = 0.09 and QOL 1.3 vs 1.5, p = 0.23). 3/11 patients undergoing surgery had a prominent 'ball-valve' median lobe, and 1/11 patients had a high bladder neck elevation contributing to symptoms. Clinical success post-PAE remains high with few patients opting for surgery or experiencing a worsening of symptoms after 12months.

A prospective study of uroflowmetry in 100 patients with lower urinary tract symptoms

Background: Uroflowmetry is diagnostic procedure of various urinary tract diseases like urethral stricture, benign prostatic hyperplasia, neurogenic bladder, detrusor muscle overactivity by calculating the rate of urine expulsion against the time unit in second. Uroflowmetry is simple and non-invasive diagnostic method.Methods: This is a prospective study of 100 cases which fulfil inclusion and exclusion criteria. After taking informed written consent of the patients, they have gone under uroflowmetry study by Urocap 3 uroflowmeter, and graphs were obtained and result analysed.Results: Maximum number of patients has prolonged curve graph were diagnosed as benign prostate hypertrophy (BPH) (53%), dysfunctional voiding curve for detrusor overactivity (20%) intermittent flow curve for neurogenic bladder (7%), Box variety for urethral stricture (7%).Conclusions: In present study we found that uroflowmetry is helpful in diagnosis of certain urological pathologies. Common lower urinary symptoms were burning micturition, frequency and difficulty in micturition. Age group from 50-70 years was often presented with bladder outflow obstruction. Uroflowmetry overall useful in diagnosis of BPH and urethral stricture which can be supported by ultrasonography of prostate with PVRV and RGU respectively to avoid other invasive and more difficult pressure or flow urodynamic study.

A Novel Noninvasive Topological Mathematical Nomogram for Diagnosing Male Bladder Outflow Obstruction

Currently the pressure–flow (P/Q) study is considered as the golden standard for diagnosing bladder outflow obstruction (BOO), with clear invasion. In this study we established a novel topological mathematical nomogram with noninvasive free uroflow metry for predicting BOO. Based on the Hill model of topological mathematics, the detrusor contractility (DC) and, the rates of detrusor contraction velocity variation (RDCVV) of the bladder were acquired. An RDCVV less than 0.2 were considered suitable for the DC/maximum uroflow (C/Q) study. A C/Q nomogram was established via 233 cases (22 unobstructed, 49 equivocal, and 162 obstructed according to an invasive pressure/ uroflow study) with an RDCVV less than 0.2. Moreover, the C/Q nomogram was verified with 522 suitable cases with RDCVV less than 0.2 (328 obstructed, 106 equivocal, and 88 unobstructed according to an invasive pressure/uroflow study). A C/Q nomogram was successfully established and verified that have a high precision. A novel topological mathematical C/Q nomogram with noninvasive free uroflowmetry was successfully established for predicting BOO in male, with relatively high accuracy.

Re: Suprameatal Urethrolysis with Martius Flap for Refractory Bladder Outflow Obstruction following Stress Incontinence Surgery in Females.

Re: Suprameatal Urethrolysis with Martius Flap for Refractory Bladder Outflow Obstruction following Stress Incontinence Surgery in Females.

PD61-02 OUTFLOW OBSTRUCTION IS ASSOCIATED WITH (EARLIER) FILLING SENSATION AND DETRUSOR OVERACTIVITY AND (HIGHER) DETRUSOR FILLING PRESSURES IN MAN BUT ALSO IN WOMEN

INTRODUCTION AND OBJECTIVES:Clinical epidemiology suggests association of detrusor overactivity (DO) with bladder outflow obstruction (BOO) in men with prostate enlargement. Very sparse clinical re...

1470 nm Diode Laser Enucleation vs Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia: A Randomized Study.

Objective: The purpose of the current work was to comparatively assess 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH).Patients and Methods: From January 2016 to March 2017, 157 individuals with bladder outflow obstruction caused by BPH were randomized to DiLEP and PKRP groups, for prospective analysis. Of these, 152 cases were evaluated before operation and at 3, 6, and 12 months postsurgery. Patient baseline properties, presurgery data, and postsurgical outcomes were comparatively assessed, as well as complications.Results: There were no significant preoperative differences between surgical groups. DiLEP-treated cases showed remarkable reduced operative time, postsurgical bladder irrigation time, catheterization duration, and hospital stay compared with the PKRP group (P < 0.001). Hemoglobin amount decrease was markedly less pronounced after DiLEP (P = 0.004). However, no patients needed blood transfusion in either group. The decrease in sodium level showed no marked differences between the DiLEP and PKRP groups (P = 0.380). In addition, complications were comparable and no significant differences in both groups. At 3, 6, and 12 months, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were similar in both groups (P > 0.05).Conclusions: DiLEP and PKRP are similar in efficacy and safety for relieving obstruction and low urinary tract symptoms. Compared with PKRP, DiLEP has decreased risk of hemorrhage, operative time, bladder irrigation time, catheterization duration, and hospital stay. However, IPSS, QoL, Qmax, and PVR were similar for both procedures within 12 postoperative months.

Effect of Premicturitional Bladder Volume on the Accuracy of Sonographic Assessment of Post Void Residual Urine Volume Measurement by Transabdominal Ultrasonography

Introduction: The Post Void Residual Urine volume (PVRU) is frequently significant in patients with bladder outflow obstruction; especially in patients with enlarged prostate and prostatism. The PVRU forms an important part of radiological investigation. Accurate measurement of the residual urine volume changes observed serially over a period of time may indicate clinical progress. The purpose of this study was to evaluate the effect of pre-void bladder volume on PVRU measurements.&#x0D; Methods: A prospective study was conducted to determine the accuracy of PVRU measurement in patient presenting with lower urinary tract symptoms (LUTS). 50 patients with LUTS were assessed ultrasonographically for pre void and post void bladder volumes during the study period of March 2017 till August 2017. PVRU measurements done in patients with bladder filling sensation at moderate to full capacity resulted in high estimations of PVRU which was quite significant in this study.&#x0D; Results: There was significant difference in the estimated PVRU between patients having high initial premicturitional volume (546±144 ml) than those with lower or moderate filling volume (261±58 ml) with mean of 173 ml and 35 ml respectively. The difference in estimated PVRU was highly significant with p value of &lt; 0.0001.&#x0D; Conclusions: Measurement of pre void urinary bladder volume with an uncomfortably full bladder results in high post micturitional (PMRU) values even in most patients without lower urinary tract symptoms which may be false-positive. We advise that initial or pre-void urine volume be measured when the patient has initial or moderate feeling of bladder fullness.

Tips and Tricks for Safe Morcellation with the Lumenis VERSACUT

Abstract Introduction: Holmium laser enucleation of the prostate (HoLEP) is an effective treatment option for bladder outflow obstruction secondary to prostatic enlargement. However, concerns about bladder mucosal injuries secondary to morcellation of the prostatic adenoma after enucleation slow the learning curve and prevent some urologists from learning the procedure. We reviewed 13 years of experience in a single center and suggest some tips and tricks to perform a safe and quick morcellation. Materials and Methods: A retrospective review of a prospective database of all HoLEP procedures performed by or under supervision of a single consultant urological surgeon was undertaken. Laser enucleation was performed using the Lumenis Pulse™ 120 Holmium laser and morcellation with the Lumenis VERSACUT™ tissue morcellator system. Data were recorded for morcellation time, retrieval time, and specimen weight and all case notes were reviewed for morcellation injury. Results: Between December 2003 and March 2017, 1...

Onabotulinum toxin A Injections in Men With Refractory Idiopathic Detrusor Overactivity

ObjectiveTo establish the effectiveness and safety profile of Onaboulinum toxin A (BTX-A) in men with idiopathic detrusor overactivity and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor BTX-A injections in improving symptoms and quality of life in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether. Materials and MethodsData patient undergoing BTX-A for refractory OAB with idiopathic detrusor overactivity on urodynamics were extracted from our center's prospectively maintained database. Incontinence impact questionnaire-7 and urogenital distress inventory-6 scores were collected at baseline and 4-12 weeks together with data regarding urinary retention requiring clean intermittent self-catheterization (CISC) and urinary tract infection (UTI). Urodynamic studies were assessed where available to see if voiding dysfunction and CISC were predictable. ResultsSixty-five men received 133 BoNT-A treatments in the 15-year period representing 27.8% of those with refractory OAB. Baseline urogenital distress inventory-6 and incontinence impact questionnaire-7 fell by 4.2 (P = .00) and 6.0 (P = .00) points for men and by 6.0 (P = .00) and 11.1 (P = .00) for women, respectively. De novo CISC was required in 46 (42.6%) men and 107 (35.3%) women (P = .10). UTI was reported in 36 (29.0%) men and 86 (27.0%) women (P = .73). The bladder outflow obstruction index and the bladder contractility index did not reliably predict CISC requirement. ConclusionMen with refractory OAB experience significant improvement in quality of life scores following BTX-A, though the benefit appears greater in women. The requirements for CISC and UTI rates were similar between sexes.

Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases

ObjectivesTo report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia. Patients and methodsOur inclusion criteria were an International Prostate Symptom Score (IPSS) of >15 and a quality-of-life (QoL) score of >3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR; >100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded. ResultsIn all, 139 men were included in the study. The mean age was 67.8 years. The IPSS and QoL score improved by 17.6 and 2.6, respectively. The flow rate increased from a mean of 9.6 mL to 31.2 mL and the PVR decreased from a mean of 131 mL to 30 mL. On univariate and multivariate analyses, operating time was a predictive factor for haemoglobin drop during the operation. Heparin prophylaxis was the only risk factor identified for postoperative bleeding. Two patients (0.01%) required blood transfusion. One patient (0.007%) required re-intervention for bleeding control, and two patients developed urethral and bladder neck strictures (0.01%). ConclusionThuLEP is safe and reproducible. Whilst it significantly reduces intraoperative bleeding as compared to transurethral resection of the prostate, operating time and perioperative heparin prophylaxis may still lead to a Hb drop and constitute a risk factor for postoperative bleeding. Therefore, a potential risk of deep vein thrombosis requiring heparin prophylaxis should be carefully considered and balanced with the expected clinical benefit of the operation.

Is loss of power output due to laser fiber degradation still an issue during prostate vaporization using the 180 W GreenLight XPS laser?

To investigate whether heat-induced fiber degradation and loss of power output, which occurred during GreenLight laser vaporization (LV) of the prostate using the first- and second-generation 80 and 120W laser, are still an issue during LV using the upgraded third generation 180W GreenLight XPS™ laser. Laser beam power output of 53 laser fibers was measured at baseline and after every 25kJ of delivered energy during routine 180W GreenLight XPS™ LV in 47 patients with prostatic bladder outflow obstruction. After the procedures, the fiber tips were microscopically examined. The median applied energy per patient was 178kJ [interquartile range (IQR): 106-247]. Loss of power output during the procedure was detectable in all fibers. After the application of 25, 150, and 250kJ, the median power output decreased to 77% (IQR 59-87), 57% (IQR 32-71), and 51% (IQR 37-64) of the baseline value. Nine fibers (17%) remained on a relatively high power output level (> 80% of the initial output), while 13 fibers (25%) showed an end-of-procedure power output of less than 20%. Microscopy of the fiber tip revealed mild-to-moderate overall degradation and increasing degradation with higher energy delivered. Despite changes in fiber design, heat-induced fiber damage and loss of power output remain an issue during 180W GreenLight XPS™ LV. Whether modifications of the surgical technique can prevent impairment of fiber performance needs to be further evaluated.

Overactive bladder in men: a practical approach.

Overactive bladder (OAB) is a significant source of morbidity in males, with a prevalence of 10–16%, and with only a small fraction of these being treated.1–3 OAB results in considerable and progressive deleterious effects on the productivity and quality of life (QoL) of patients, leading to a substantial economic burden of disease, related to increased absenteeism, worry about interruption and scheduling of meetings, early retirement, and permanent disability.4,5 Symptoms of OAB are often attributed to bladder outflow obstruction (BOO) in males, resulting in misdiagnosis and delays in treatment. Given its prevalence, QoL impact, and the availability of initial non-invasive and well-tolerated management options, OAB is often best addressed in the primary care setting. ### History The International Continence Society (ICS) defines OAB as a symptom complex primarily dominated by urinary urgency with or without urge incontinence, usually associated with urinary frequency and nocturia in the absence of other pathology. In contrast, bladder outlet obstruction (BOO) customarily presents with weak or intermittent stream, hesitation, straining, and incomplete emptying. Patients may present in practice with a spectrum of voiding complaints and symptoms of both OAB and BOO may be found in any given patient (in part due to coexistent disease and/or overlapping pathophysiology). If …

Ultrasound estimated bladder weight in the detection and post-operative follow-up of bladder outflow obstruction

This study was performed to standardize the ultrasound estimated bladder weight as an additional non-invasive test for the measurement of the bladder outflow obstruction and to measure the therapeutic effects of bladder outflow obstruction in the follow-up after surgical correction of obstruction. This study was conducted from December 2012 to May 2014 where the sample size was 55 and sampling technique was purposive. In bladder outflow obstruction patient, transabdominal sonography was performed using a 7.5 MHz. probe. The anterior bladder wall thickness was measured in three points in the midline 1 cm apart and the average value was recorded. After that bladder volume was measured by ultrasonogram. In pre- and post-operative groups ultrasound estimated bladder weight was measured from bladder wall thickness and bladder volume. In this study, the mean ± SD of age was 48.8 ± 15.0 years. In bladder outflow obstruction patient, the pre-operative ultrasound estimated bladder weight was 117 ± 45.1 g which was reduced to 53.9 ± 10.8 g three months after surgical correction of obstruction. The ultrasound estimated bladder weight is a non-invasive, cheap and easily available additional diagnostic tool for detecting bladder outflow obstruction as well as it can measure the therapeutic effects in post-operative period.

Surgical Management and Post-Operative Outcomes of Urinary Outflow Obstruction: Experience of 50 Cases in Bangladesh

Background: Management of urinary outflow obstruction is very crucial.Objective: The purpose of the present study was to see the different management of urinary outflow obstruction with their post-operative outcomes.Methodology: This non-randomized clinical trial was conducted in the Department of Surgery at Rajshahi Medical College, Rajshahi, Bangladesh from September 1994 to December 1995 for a period of one year and three months. All the patients who were presented with bladder outflow obstruction and were admitted in the general surgical unit of the hospital were taken as study population. These patients were surgically managed in different procedures. The follow up was done to record the post-operative surgical outcomes.Result: A total number of 50 patients were recruited for this study. Benign enlargement of prostate was found in 13 cases of which 11(22.0%) cases were managed by suprapubic transvesical prostatectomy. Impacted urethral stone was found in 13 cases of which 4(8.0%) cases were managed by urethro-lithotomy followed by repair of urethra and indwelling catheter. Stricture urethra was found in 11 cases and all cases (100.0%) cases were managed by intermittent dilatation under general anesthesia. In 7 cases of rupture urethra, initially all patients were managed by suprabpublic cystostomy which was 7(14.0%) cases in number. All the 3 cases of carcinoma prostate were managed by prostatectomy and radiotherapy plus hormone therapy. A total number of 16 patients were managed by prostatectomy of which 1(2.0%) case was developed immediate postoperative hemorrhage which was managed by blood transfusion and continuous irrigation with normal saline. One patient developed postoperative clot retention due to blockage of Foley’s catheter, two patients developed postoperative incontinence, immediately after removal of the catheter. Out of 11 patients of impacted urethral stone, one developed urethral fistula and one developed UTI. Recurrent stricture urethra occurred in 3 patients. Seven patients with rupture urethra, 3 developed stricture urethra and 3 developed stricture urethra.Conclusion: In conclusion different surgical procedure are employed during the management of urinary outflow obstruction and immediate postoperative hemorrhage, postoperative clot retention, postoperative incontinence, urethral fistula, UTI and recurrent stricture urethra are the most common complication after surgical management of urinary outflow obstruction patients.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 84-88

Aetiology of Urinary Outflow Obstruction at a tertiary Care Hospital in Bangladesh

Background: There are several etiologies of urinary tract obstructions.Objective: The purpose of the present study was to find out the etiology of urinary tract obstructions. Methodology: This cross-sectional study was conducted in the Department of Surgery at Rajshahi Medical College, Rajshahi, Bangladesh from September 1994 to December 1995 for a period of one year and three months. All the patients who were presented with bladder outflow obstruction and were admitted in the general surgical unit of the hospital were taken as study population.Result: A total number of 50 patients were recruited for this study. The most frequent cause of bladder outflow obstruction was benign enlargement of prostate (26.0%), next common cause was impacted urethra stone (22.0%) and stricture urethra (22.0%). Rupture urethra was found in 7(14.0%) cases and carcinoma of prostate was found in 3(6.0%) cases.Conclusion: In conclusion the most frequent cause of bladder outflow obstruction is benign enlargement of prostate, impacted urethra stone and stricture urethra.Journal of Current and Advance Medical Research 2018;5(1):3-6

Cystometry filling phase sensation volumes and pressures are affected by (the grade of) bladder outflow obstruction, both in men and identical in women

Cystometry filling phase sensation volumes and pressures are affected by (the grade of) bladder outflow obstruction, both in men and identical in women

The role of emerging therapies in the treatment of benign prostatic hyperplasia. Is it any place

Benign prostatic hyperplasia (BPH) may lead to bladder outflow obstruction and symptoms in older men The latest developments as far as it concerns surgical treatment are focused on two principles: an office based procedure without the need for general anesthesia; and minimizing incontinence and sexual dysfunction related side effects while retaining satisfactory clinical efficacy. The aim of this review is to evaluate evolving minimally invasive therapies for the treatment of lower urinary tract symptoms (LUTS) caused by BPH in which ongoing clinical trials show early promise, namely, intra-prostatic injections, alcohol ablation, aquablation, the Rezum device, prostatic artery embolization (PAE), and histotripsy.

Urine Leak Following Kidney Transplantation: An Evidence-based Management Plan

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. On-going urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life, reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.