Presentation Authors: Sanjay Kumar Sureka*, Rahul Jena, Uday Pratap Singh, Aneesh Srivastava, Sanchit Rustagi, Lucknow, India
Introduction: Up to 20 % of renal transplant recipients have anatomical or functional bladder or the outlet abnormalities which are either pre-existing or evident before the transplant or are latent and manifest during the post-transplant follow up. This study focussed on overview, bladder management and transplant outcome in patients with latent bladder or the outlet abnormalities which manifested after the transplant in recipient.
Methods: A prospective observational study of patients who underwent renal transplant with latent bladder abnormalities which manifested with a variable spectrum of LUTS or the graft dysfunction was done from January 2012 to July 2017. We identified and noted the etiopathogenesis, post-transplant interventions required; bladder related complications and long term graft function.
Results: Of the 720 renal transplants performed during this period, 160 patients (22.2%) (Mean Age 28 Â± 8.5 Years) had new onset LUTS or latent bladder abnormalities which manifested within 1 month of renal transplant. The study cohort was stratified in two groups on the basis of type and duration of intervention required; Group 1 (â‰¤ 6 months of nonsurgical treatment, n= 112), group 2 (> 6 months of non surgical treatment and or requiring surgical treatment, n=48). Most common presenting symptom was dysuria (n=110) followed by increased frequency (n=104), poor stream (n=72) or both (n=60). Etiologies included overactive bladder OAB (n=76), transient voiding dysfunction (n =52), functional bladder neck obstruction (n=10), dysfunctional voiding (n=4), diabetic cystopathy (n=5) and BPH or related cystopathy (n=8), unidentified aetiology (n=5). Group 1 was managed with short-term medical management with anticholinergics or alpha blockers or both and improved within six months. Whereas group 2 were managed with continuous pharmacotherapy for > 6 months or CIC and urotherapy (n=39), bladder neck incision (n=5) or TURP/TUIP (n=4). Recurrent UTI occurred in 15 (13%) Vs 18 (38%), patients in group 1 Vs group 2 (p=0.01) in the post-transplant period. Graft survival was satisfactory at 1 year and were comparable between the groups (95% Vs 91%, p=0.47).
Conclusions: About one in five transplant recipients manifests new onset LUTS and are detected to have either bladder dysfunction or outlet abnormalities in the early post transplant period. Majority of them improve on short-term nonsurgical therapy. However those requiring long-term nonsurgical or surgical treatment are more likely to develop frequent urinary tract infections. Overall outcome of renal transplant in terms of graft function was satisfactory following optimal bladder management.