UPJ INSIGHT: A Contemporary Evaluation of Urological Outcomes After Renal Transplantation

By: Aidan Kennedy, MD; MaryJoe K. Rice, MD; Mark Waguespack, MD; Wen Yan Xie, MD; Talal Al-Qaoud, MD; Rena D. Malik, MD | Posted on: 02 Feb 2023

Kennedy A, Rice MK, Waguespack M, Xie WY, Al-Qaoud T, Malik RD. A contemporary evaluation of urological outcomes after renal transplantation. Urol Pract. 2022;10(1):74-82.

Study Need and Importance

Guidelines regarding the need for urological evaluation or testing prior to renal transplantation are lacking. This study sought to identify patient factors that increase the risk of postoperative urological complications, thus identifying patients who may benefit from focused urological assessment and post-transplant care.

Table. Logistic Regression Models Predictive of Primary Outcomes

Unexpected urology visit (n=191)		Postoperative urinary retention (n=47)		Postoperative UTI (n=124)		Postoperative urosepsis (n=124)
Adjusted odds ratio (95% confidence interval)	P value	Adjusted odds ratio (95% confidence interval)	P value	Adjusted odds ratio (95% confidence interval)	P value	Adjusted odds ratio (95% confidence interval)	P value
Female: 0.557 (0.382-0.814)	.002	HTN: 0.298 (0.129-0.688)	.005	Female: 2.421 (1.674-3.504)	< .001	Female: 2.301 (1.510-3.506)	< .001
BPH: 2.060 (1.023-4.148)	.043	BPH: 2.824 (1.086-7.343)	.033	Prostate cancer: 3.083 (1.450-6.553)	.003	Prostate cancer: 3.278 (1.427-7.526)	.005
Urinary retention: 4.619 (0.984-21.681)	.052	Prostate surgery: 3.042 (0.907-10.205)	.072	Recurrent UTI: 2.116 (1.330-3.363)	.002	Stone disease: 0.363 (0.140-0.935)	.036
Shown above are the variables that either demonstrated or approached statistical significance on logistic regression modeling. Abbreviations: BPH, benign prostatic hyperplasia; HTN, hypertension; UTI, urinary tract infection.

What We Found

In the Table, we present factors that highlight these patient characteristics. Female sex, history of benign prostatic hyperplasia (BPH), and history of urinary retention led to higher rates of unexpected urology visits post-transplant. Postoperative urinary retention was more likely in patients with hypertension, BPH, or prior prostate surgery. Female patients and patients with history of prostate cancer were more likely to experience postoperative urinary tract infection (UTI) or urosepsis.

Limitations

Information on patient follow-up was limited when patients chose to receive additional urological, surgical, or medical care outside of the tertiary care system we studied. Length of time for stent placement was not recorded, and patient factors such as adherence to medications was not recorded, which may have affected our observed outcomes. Data on kidney graft functional outcomes were beyond the scope of this study.

Interpretations for Patient Care

In patients with advanced age, history of diabetes, BPH, prostate cancer, previous prostate surgery, recurrent UTIs, or other coexisting cancers, prompt urology referral and workup pre-transplant, with closer postoperative follow-up, may prove beneficial to improve outcomes. Our experience has demonstrated that these patients are at an increased risk of postoperative UTI, urinary retention, and need for unexpected urological consultation. These patients should be referred to a general urologist for follow-up within 4-6 weeks of surgery. In patients with hypertension, BPH, or diabetes, pre-transplant urodynamics may be indicated to anticipate postoperative retention and complications.