Urodynamics in the Transplant Population

Urodynamic testing (UDS) is a valuable tool for understanding the safety of the lower urinary tract (LUT). The goal of this review is to provide evidence-based indications for use of UDS in both the pre- and post-kidney transplant (KT) settings.

Pre-transplant bladder cycling with UDS for anuric or oliguric patients is no longer recommended. Instead, UDS aids in identifying LUT anomalies that may require optimization prior to transplant, especially in patients with known urologic etiologies of end-stage renal disease (ERSD). In pre-KT patients with recurrent urinary tract infections (UTIs) or prior urologic/pelvic interventions, UDS should be used judiciously when the etiology of LUT dysfunction is unclear. In the post-transplant setting, urologists are often consulted for LUT symptoms (LUTS), hydronephrosis, urinary retention, declining renal function, and most commonly, recurrent UTI. Again, UDS should not be routinely performed first line, but as an adjunct to distinguish similarly presenting LUT etiologies such as bladder outlet obstruction (BOO) and bladder dysfunction.

UDS remains the gold standard for characterizing the LUT, and when utilized appropriately, can identify factors promoting graft and patient survival after KT.