J Korean Med Sci 2005; 20: 75-8 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Clinical Characteristics of Renal Transplant Recipients that Underwent Urologic Surgery for de novo Disease Before and After Transplantation The pre-transplantation goal of the urologist is the optimization of urinary tract con- dition. Therefore, urologic surgery may be needed before or after renal transplan- tation. We analyzed the results of urologic surgery performed because of de novo urologic diseases. Between January 1986 and January 2001, 281 patients under- went renal transplantation, and 23 urologic surgical procedures were performed on 21 transplant recipients before or after renal transplantation because of de novo uro- logic diseases. By review the major reasons for urologic surgery in recipients were polycystic kidney diseases, vesicoureteral reflux, and dysfunctional voiding disorders. Nineteen surgical corrective procedures were done average 2.9 months before trans- plantation. The mortality rate was 10.5%. Four patients underwent urologic surgery at an average 57.5 months after transplantation. We highlight the fact that patients with uremia are vulnerable to surgical complications, and conclude that more inten- sive long-term urologic follow-ups should be conducted on recipients. Key Words : Kidney Transplantation; Urology; Abnormalities; Urologic Surgical Procedures Kwan-Sik Bae, Jung-Sik Huh*, Young-Joo Kim*, Sung-Goo Chang Department of Urology, School of Medicine, Kyung Hee University, Seoul; Department of Urology*, College of Medicine, Cheju National University, Jeju, Korea Received : 24 February 2004 Accepted : 11 August 2004 Address for correspondence Sung-Goo Chang, M.D. Department of Urology, Kyung Hee University Medical Center, 1 Hoegi-dong Dongdaemun-gu, Seoul 130-702, Korea Tel : +82.2-958-8533, Fax : +82.2-959-6048 E-mail : sgchang@khu.ac.kr INTRODUCTION Renal transplantation is a successful and widely used treat- ment for renal insufficiency. Better organ matching, improved surgical techniques, and more effective immunosuppressive drugs have led to a steady increase in graft survival. Although major technical obstacles have been overcome, strict attention to detail is still mandatory in every phase of the transplantation process from initial recipient evaluation until surgical procedure completion. Pathological findings of urinary tract can occur in up to 25% of patients with end-stage renal disease (1). Therefore, urologic surgery may need to be performed before or after renal transplantation. The present study reviews the outcomes of 23 urologic sur- gical procedures performed because of de novo urologic dis- eases in 21 renal transplant recipients. MATERIALS AND METHODS Between January 1986 and January 2001, 281 patients underwent renal transplantation at Kyung Hee University Medical Center. All patients received organs from living relat- ed donors. Twenty-one of these patients also underwent uro- logic surgery before or after renal transplantation because of de novo urologic disease. Patients that required urologic surgery because of complications after renal transplantation were ex- 75 cluded. Urinalysis, urine culture, and urodynamic studies were performed in all patients. In anuric patients, bladder washing for cytology and culture were performed. The urologic phys- ical examinations included an assessment of the bulbocaver- nous reflex, anal tone, and perineal sensation. The recipients also underwent voiding cystourethrography prior to renal transplantation. Renal function was followed postoperatively by monitoring serum creatinine and urine output. Additional imaging studies were done according to clinical need. RESULTS Patient characteristics Overall, 21 patients (7.4%) underwent 23 urologic surg- eries because of de novo urologic disease. Mean patient age was 38.1 yr. Nine patients were male and 12 were female, and all recipients received grafts from related donors. Urologic surgery before renal transplantation Nineteen urologic surgical procedures were performed on 17 patients prior to renal transplantation, and these proce- dures were done an average 2.9 months (range, 0-8 months) before transplantation. Two patients underwent dual surgery, i.e., bilateral nephroureterectomy with augmentation entero- cystoplasty for bilateral vesicoureteral reflux (VUR) with a