EVALUATION OF VOIDING CYSTOURETHROGRAPHY PRIOR TO RENAL-TRANSPLANTATION

In many centers, voiding cystourethrography is a routine part of pretr ansplantation assessment of the lower urinary tract, To assess the val ue of this investigation, a retrospective review of transplant candida tes evaluated in our center over 2 years was undertaken, A total of 51 7 patients were fully evaluable, Only 13 voiding cystourethrograms (VC UGs) (2.5%) of 517 were found to be abnormal, Three patients with refl ux alone did not require intervention before transplantation, Four pat ients with decreased bladder capacity underwent hydrodistention, Two p atients increased their capacity to over 150 ml and two patients faile d distention, one requiring an ileal conduit and the other requiring a n augmentation cystoplasty. Three patients had increased postvoid resi dual (PVR), Two patients started clean intermittent catheterization, O ne required prostate resection for benign prostatic hypertrophy. One p atient with reflux and decreased bladder capacity refused treatment, O ne patient with reflux combined with increased PVR started clean inter mittent catheterization and was cleared for transplant surgery. One pa tient with decreased bladder capacity and increased PVR had a stroke a nd was excluded from transplantation, All 13 patients with abnormal VC UGs had a prior urologic history, In total, only 56 of 517 patients ev aluated had a prior urological history, Each VCUG costs approximately $500, Limiting VCUG studies to those patients with a prior urological history would have resulted in a significant cost savings, Hence, we r ecommend that only patients with a prior urological history should und ergo this costly and often distressing examination.