Value of the Need for Voiding Cystourethrography Before Renal Transplantation

Abstract

RENAL TRANSPLANTATION has become a com- mon modality for patients with end-stage renal dis- ease. In preparation for renal transplantation, patients undergo extensive and costly laboratory and radiological evaluation. This comprehensive workup is used to evaluate the primary disease causing renal failure and its risk of recurrence in the graft and to discover any occult malignan- cies or infections that could be devastating once the patient receives immunosuppressive therapy after transplant sur- gery. Urological investigation is an essential component of this workup. The aim is to assess the need for nephrectomy and to determine the suitability of the urinary reservoir. In many centers, voiding cystourethrography (VCUG) has been included in urological evaluation. Testing the VCUG would ensure that the bladder is of sufficient capacity and to assess any conditions that could damage the transplanted kidney. Although the VCUG is important in delineating anatomic and functional abnormalities of urinary tract, only 25% of potential renal transplant patients may prove to have a significant urologic abnormality discovered during testing. Thus, the majority of patients are found to have no urologic abnormalities on pretransplantation evaluation using the VCUG. 1 We hypothesized that the VCUG was not valuable in all patients, and that if a subset of patients could be identified where this test was indicated, then the morbidity and cost associated with this investigation would be considerably decreased and would optimize the use of the VCUG in preparation of these individuals for renal replacement.