ESPN 51th Annual Meeting

ESPN 2018


 
Are non-invasive urodynamics indicated for all children requiring kidney transplantation?
HOLLY BLAIR 1 ANNE WRIGHT 1 JOANNA CLOTHIER 1

1- EVELINA LONDON CHILDRENS HOSPITAL, GUYS AND ST. THOMAS NHS FOUNDATION TRUST
 
Introduction:

 It is recognised that careful urological management is required to optimise kidney transplant function in patients with lower urinary tract dysfunction (LUTD) as the cause of end stage renal failure. However, the prevalence of bladder dysfunction in those with non- LUTD-related renal failure is unknown. Since 2012 non-invasive urodynamic assessment has been part of our pre-transplant work up in those with adequate urine output and post-transplant assessment in those with voiding symptoms, but is it necessary?

Material and methods:

 Retrospective data collection on all patients transplanted between 2012-2017 including renal diagnosis, voiding history, 48-hour bladder diary, uroflowmetry/ 4-hour voiding observation, bladder capacity (BC) and post void residual (PVR) plus subsequent bladder management. Those with obstructive uropathy, renal dysplasia, reflux and neuropathic bladder were excluded. Definitions comply with ICCS 2014 terminology.

Results:

 Of 69 patients transplanted, 36 patients were included with primary renal diagnosis: glomerular (n=19), unknown (n=6), TIN (n=5), renovascular (n=3), metabolic (n=2) and malignancy (n=1). 20 completed a full assessment, (no assessment in16 who were oligo-anuric prior to transplant and had no voiding symptoms at 6 months following). Of those completing a full assessment: 85% had abnormal voiding history, 40% had abnormal BC, 65% significant PVR and subsequent bladder management was recommended in 14 (70%): bladder training (7), clean intermittent catheterisation (CIC) (5) anticholinergic medication (2). Interestingly, one patient with no voiding symptoms was subsequently found to have an underactive detrusor requiring CIC.

Conclusions:

 Bladder dysfunction is common in patients with non-LUTD-related renal failure with 39% of patients described here requiring bladder management. Screening with non-invasive urodynamics should be considered in all patients receiving a kidney transplant.