Problems concerning the bladder in renal transplantation. Prognosis--replacement possibilities.

Problems arising from the lower urinary tract in patients with a terminal renal insufficiency are usually known long before transplantation; they can even be the cause of chronic renal failure. A careful investigation of morphology and function of upper and lower urinary tract before performing renal transplantation is still of great importance. In up to a quarter of the cases pathological findings can be recorded. Whether a supravesical urinary diversion or a bladder augmentation has to be performed in case of insufficient bladder function is dependent on the urodynamic results. However, so far there are no reliable prognostic factors indicating whether or not a bladder with increased capacity due to renal transplantation reacts with normal pressure. An investigation of the lower urinary tract also has to be carried out in patients who already have a supravesical urinary derivation at the time of renal transplantation, as a possible removal always has to be taken into consideration. Survival rate following transplantation in patients with a conduit is not lower than in those with a normal bladder.