Bladder Disorders and Voiding Dysfunction After Kidney Transplantation
Özet
Kidney transplantation is the most effective treatment for end-stage renal disease; however, long-term graft survival largely depends on the functional integrity of the lower urinary tract. Bladder disorders and voiding dysfunction after transplantation are common, particularly in patients with a history of prolonged anuria or oliguria. These conditions are associated with reduced bladder capacity, impaired compliance, and detrusor dysfunction. Comprehensive evaluation, including clinical assessment, uroflowmetry, post-void residual measurement, and selective urodynamic studies, is essential for identifying high-risk patients. Common dysfunction patterns include low-capacity bladder, overactive bladder, hypocontractile bladder, and neurogenic bladder. If untreated, these conditions may lead to complications such as urinary tract infections, vesicoureteral reflux, and obstructive uropathy, ultimately compromising graft function. A stepwise management approach, incorporating pharmacological therapy, clean intermittent catheterization, and surgical interventions, is crucial for optimizing outcomes and preserving long-term graft function.
Referanslar
Neves Neto JF, Palomino Z, Mizuno Watanabe IK, et al. Pretransplant defunctionalized bladder—overrated condition? Neurourol Urodyn. 2018.
Asakura H, Nakamura K, Tachibana M, et al. Evaluation of lower urinary tract function in renal transplant recipients by urodynamic study. Transplant Proc. 1998.
Zachoval R, Krhut J, Slatinska J, et al. The relationship between lower urinary tract dysfunctions and urinary leakage from ureterocystoneoanastomosis in male patients after kidney transplantation. Bratisl Med J. 2021.
De Wall LL, Oomen L, Glaap-Roeven F, et al. Outcome of a thorough screening of lower urinary tract function in all pediatric kidney recipients. Pediatr Transplant. 2020.
Amesty MV, García-Vaz C, Espinosa L, et al. Long-term renal transplant outcome in patients with posterior urethral valves. Front Pediatr. 2021.
Wicaksono I, Rahardjo HE. Factors associated with postoperative voiding dysfunction post renal transplantation. Transplant Proc. 2020.
Rude T, Nassiri N, Naser-Tavakolian A, et al. The role of urodynamics in the pre-transplant evaluation of renal transplant. Curr Urol Rep. 2019.
Kamiya KA, Jose Benito AA, Ernesto LG Jr. Evaluation of cystography/voiding cystourethrography prior to renal transplantation: a systematic review and meta-analysis. Int Urol Nephrol. 2025.
European Association of Urology. Renal transplantation. In: EAU Guidelines. 2026 edition. Arnhem, The Netherlands: EAU; 2026. Available at: https://uroweb.org/guidelines
Aikawa A, Muramatsu M, Takahashi Y, et al. Surgical challenge in pediatric kidney transplant: lower urinary tract abnormality. Exp Clin Transplant. 2018.
Errando C, Batista JE, Caparros J, et al. Is bladder cycling useful in the urodynamic evaluation previous to renal transplantation? Urol Int. 2005.
Righetto M, Mancini M, Modonutti D, et al. Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate. World J Urol. 2021.
Herthelius M, Öborn H. Urinary tract infections and bladder dysfunction after renal transplantation in children. J Urol. 2007.
Sabnis RB, Singh AG, Ganpule AP, et al. The development and current status of minimally invasive surgery to manage urological complications after renal transplantation. Indian J Urol. 2016.
Orecchia L, Rosato E, Siragusa L, et al. Percutaneous tibial nerve stimulation improves lower urinary tract dysfunction and infection rate in a kidney transplant recipient with augmentation cystoplasty: a case report and literature review. Transplant Proc. 2022.
Salman B, Hassan A, Sultan S, et al. Renal transplant in the abnormal bladder: long-term follow-up. Exp Clin Transplant. 2018.
