PRETRANSPLANT UROLOGIC EVALUATION

Objective. Although a number of pretransplant urologic evaluations hav e been recommended in the literature, their efficacy has not been vali dated. This study was undertaken to evaluate a standardized urologic d iagnostic protocol for potential adult transplant recipients. Methods. One hundred consecutive adult transplant candidates were prospectivel y evaluated with a complete history and physical examination, renal ul trasonography (US), voiding cystourethrography (VCUG), urinalysis, and urine culture. Other diagnostic studies including cystoscopy and retr ograde pyelography were performed as indicated. Results. Urologic mali gnancies were diagnosed in 3 patients that included Stage A2 prostate cancer, Stage TA transitional cell carcinoma of the bladder, and Stage II renal cell carcinoma. The only significant abnormality detected by renal US was renal cell carcinoma in 1 patient. Twenty-six individual s had VCUG abnormalities, but these could not be predicted based on pa tient characteristics. However, VCUG was normal in all nondiabetic pat ients without voiding symptoms or a history of urinary tract infection s. Thirteen patients had hematuria and were evaluated with cystoscopy and retrograde pyelography. One individual (7.6%) had a significant ab normality (bladder tumor) detected during cystoscopy. Retrograde pyelo graphy demonstrated no clinically significant abnormalities in this pa tient group. Eighteen patients had sterile pyuria and underwent simila r endoscopic evaluation. Cystoscopic examination was normal in all the se individuals, and retrograde pyelography showed either normal or cli nically insignificant papillary necrosis. Conclusions. Although renal US has a low diagnostic yield, all adult transplant candidates should undergo this study because of the high prevalence of renal cell carcin oma in this cohort. VCUG also should be performed prior to transplanta tion, but it may be omitted in nondiabetic patients without voiding sy mptoms or a history of urinary tract infection. Transplant candidates with hematuria warrant an endoscopic evaluation, although this may not be necessary in individuals with sterile pyuria.