WTP5.08 Structural urological abnormality and successful renal transplant

Background and Aims Structural urological abnormalities involving the lower urinary tract can often present significant challenges in renal transplantation. This case highlights a successful renal transplant in a patient with a complex urethral stricture, managed by perineal urethrostomy, demonstrating the feasibility of transplantation in such scenarios. Case Details A 72-year-old male with hypertension-induced end-stage renal disease (ESRD) on hemodialysis thrice weekly and making 200-250 mL of urine daily. His medical history included coronary artery bypass grafting (CABG) for a prior myocardial infarction and mechanical aortic valve replacement for bicuspid valve stenosis. Pre-transplant evaluation showed no lower urinary tract symptoms. However, during transplantation, catheterization was challenging, prompting urology consultation, which revealed a dense bulbar urethral stricture. Given a contracted bladder, a suprapubic catheter (SPC) was not viable, and the transplant was aborted. Following multidisciplinary assessment and considering the patient’s high cardiac risk, elective perineal urethrostomy instead of more complex urological reconstructions. One year post-urethrostomy, the patient underwent successful renal transplantation, with primary graft function achieved. In the immediate post-op period, he developed a small hematoma, managed conservatively, and a culture-negative urinary tract infection (UTI) following stent removal. Persistent lower urinary tract symptoms (LUTS) were attributed to an overactive bladder, responding well to anti-muscarinics. Six months post-transplant, the graft function remained stable. Conclusion Renal transplantation in patients with urinary diversion remains a challenging but feasible procedure. This case is the first reported instance of a successful transplant following perineal urethrostomy. Close postoperative monitoring for complications, including infections, is essential for optimal outcomes.