Pre-transplant urologic investigation and treatment of end stage renal disease.

We investigated 112 patients with end stage renal disease. Clinical evaluations included cystoscopy, cystometry, voiding cystography, bilateral retrograde pyelograms, history and physical examination, and appropriate serum and urinary studies. Of the 112 patients 28 (25 per cent) had significant abnormalities of the urinary tracts. Of the 28 patients 17 had lower tract abnormalities, such as detrusor hyporeflexia, obstructing prostatic hyperplasia and urethral stricture, and 11 had upper tract disease, 9 of whom required a pre-transplant surgical procedure. Included in the group of 9 patients were those with polycystic kidneys, staghorn calculi, renin-related renal hypertension, chronic pyelonephritis and persistent vesicoureteral reflux. None of the azotemic patients had significant morbidity with the timing of the surgical procedures. We believe that eradication of such conditions in the pre-transplant period resulted in a more suitable candidate for renal transplantation. Furthermore, we believe that our finding of 25 per cent abnormalities underscores the need for early urologic evaluation of these patients to ensure their functional capabilities as a recipient.