MP59-16 URINARY OBSTRUCTION IN SYMPTOMATIC PATIENTS UNDERGOING RENAL TRANSPLANTATION: PROPOSAL OF A SCORE BASED ON URODYNAMIC PARAMETERS

Abstract

INTRODUCTION AND OBJECTIVE: After renal transplantation (RT) and restored diuresis, lower urinary tract symptoms (LUTS) become more evident with a risk for graft function. Urodynamic (UD) defines the functional status of the lower urinary tract and encompass other tests in preoperative management. Few studies have been published on UD parameters in transplanted patients. Our purpose was to assess a score system to predict obstruction in these patients before RT, to avoid complications METHODS: From 01/2005 to 12/2018 278 male patients >50 yrs underwent RT in the Transplant Center of our Hospital. 60(26%) developed LUTS after RT and underwent UD. Patients' data have been collected and analyzed retrospectively. Follow-up was possible in 50 (83%) patients, with a medium of 4,2±2,4yrs (minimum:9 months) RESULTS: Patients' median age was 56(47-64)yrs. 36(60%) patients were not in therapy for LUTS, 24(40%) took a1- blockers. 42(70%) patients underwent UD after RT: 14(33%) had diuresis >500 mL before RT, 6(14%) were oliguric and 22(53%) anuric. 18(30%) patients underwent UD before RT: 11(61%) had diuresis >500 mL, 6(33%) were oliguric and 1(6%) anuric. Within the group who underwent UD after RT:15(36%) had a IPSS>20;22(52%) IPSS 8-19;5(12%) storage LUTS. Among patients who did UD before RT:3(17%) had a IPSS>20;12(66%) IPSS 8-19;3(17%) storage LUTS. 34(57%) patients underwent transurethral resection of the prostate (TURP) following UD, 30 did UD after RT. Within patients who did UD before RT:1 underwent TURP after RT, 3 underwent TURP before RT. Patients who underwent TURP before RT had a diuresis >500 mL.18 patients who did not undergo TURP received therapy, 3 started intermittent self-catheterization. At TURP, median prostate volume was 40(32-67)mL and median duration of anuria was 94 months. Among patients who underwent TURP, 25(73.5%) had a post-void residual urine volume >1/3 of their bladder capacity (BC) and 28(82%) had a BC >200mL. No repeat TURP was performed. Creatinine levels significantly decreased 3 and 6 months after TURP in transplanted patients, with a significant improve of the peak flow rate. Statistical significance was found only between TURP and bladder capacity>350ml (p=0,033), detrusor pressure>30cmH2O (p=0,041) and duration of anuria ≤3yrs (p=0,038) CONCLUSIONS: UD could select candidates to RT who will benefit from surgery for prostatic obstruction. It would be advisable to do UD in candidates for RT (with conserved micturition and pts with anuria of less than 3 yrs), to early discriminate those who need TURP.