76 contracted bladder, and ileal diversion with bilateral nephrou- reterectomy for a neuropathic bladder with bilateral VUR. Bilateral nephrectomy was done in 7 patients with extremely large polycystic kidneys. Four of the 7 patients had recurrent bleeding into cysts, pain, and an extremely large kidney. One of these patients expired due to postoperative uncontrolled bleeding. Bilateral nephroureterectomy was performed in 6 patients with bilateral VUR and recurrent urinary tract infec- tions. One of these six expired due to postoperative bleeding. The mortality rate was 10.5% in the patients with urologic surgery before renal transplantation. Ileal urinary diversion without cystectomy was done in 3 female patients for a con- tracted or neuropathic bladder. These diversions were per- formed at the same time as the renal transplantation (Table 1). Urologic surgery after renal transplantation Four patients underwent urologic surgery an average 57.5 months (range, 2-122 months) after transplantation. One patient with recurrent urinary tract infection for VUR had a Table 1. Urologic surgery performed in recipients before renal transplantation No. of patients Procedures Bilateral nephrectomy Bilateral nephroureterectomy Ileal diversion Unilateral nephroureterectomy Augmentation enterocystoplasty Internal urethrotomy RT, renal transplantation. 7 6 1 1 de novo urologic disease Polycyctic kidney Both VUR Nuerogenic or contracted bladder Unilateral VUR Contracted bladder Urethral stricture Spontaneous rupture of native kidney Unilateral VUR Bilateral cryptorchidism BPH No. of cases 7 6 3 1 1 1 1 1 1 1 Diseases Polycystic kidney Both vesicoureteral reflux Contracted bladder Urethral stricture Time before RT (months) 4.4 2.2 8.0 1.0 3 Contracted bladder (n=2) Same time Neurogenic bladder (n=1) with RT 1 Unilateral vesicoureteral reflux 2.0 K.-S. Bae, J.-S. Huh, Y.-J. Kim, et al. nephroureterectomy 48 months after renal transplantation, and simple nephrectomy was performed 122 months after renal transplantation in a patient with spontaneous rupture of an end-stage native kidney. Bilateral orchiopexy was per- formed in a 9-yr old patient who had undergone renal trans- plantation some 4 yr previously. One patient underwent trans- urethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) because of voiding difficulties that were aggravated after renal transplantation (Table 2). We experienced one case of renal cell carcinoma in an end- stage native kidney 25 months after transplantation. How- ever, the patient refused surgery and the case details are not included in this study. Result of urologic surgery Two patients expired due to postoperative uncontrolled bleeding from bilateral nephrectomy for a polycystic kidney and bilateral nephrectomy for bilateral VUR, respectively. After ileal diversion with renal transplantation, one patient had a normal vaginal delivery. After transplantation, the two patients died due to chronic rejection with pericardial effusion and sepsis, respectively. However, graft survival was good in the other 21 patients (Table 3). Table 2. Urologic surgery performed in recipients after renal trans- plantation Procedures Simple nephrectomy Nephroureterectomy Orchiopexy, both TURP No. of patients 1 1 1 1 Diseases Rupture of native kidney Recurrent UTI for VUR of native ureter Bilateral cryptorchidism BPH Time after RT (months) 122 48 58 2.0 BPH, benign prostatic hyperplasia; RT, renal transplantation; TURP, trans- urethral resection of the prostate; UTI, urinary tract infection; VUR, vesi- coureteral reflux. Follow-up months for Graft survival (range) Other Expired 1pt Expired 1pt 150 (3-215) 18 (12-169) 119 (116-121) 1pt expired at post-RT 3 months 1pt expired at post-RT 20 months 1pt successful vaginal delivery 38 13 61 122 119 58 57 Type of surgery Time of surgery Result Bilateral nephrectomy Bilateral nephroureterectomy Ileal diversion Unilateral nephroureterctomy Augmentation cystoplasty Internal urethrotomy Nephrectomy Unilateral nephroureterectomy Orchiopexy, both TURP Before RT Before RT Simultaneous with RT Before RT Before RT Before RT After RT After RT After RT After-RT Table 3. Results of urologic surgery conducted before or after renal transplantation RT, renal transplantation; VUR, vesicoureteral reflux; BPH, benign prostatic hyperplasia; TURP, transurethral resection of prostate; pt, patient.