Urological challenges in renal transplantation

Urological evaluation is an essential component of the pre-transplantation assessment of any potential renal recipient. The main objective is to identify structural and functional abnormalities of the native urinary tract that may preclude transplantation or threaten patient or graft survival. Mainly the assessment should be tailored to determine the need for pre transplant nephrectomy and the suitability of the lower urinary tract to receive the graft. Meticulous measures taken to harvest a healthy ureter which is properly implanted with a non refluxing method is mandatory since ureteric complications could arise at any time and could be an unforgiving threat to the graft viability or even patient survival. These post operative complications are now increasingly managed by endourological or percutaneous image guided techniques which have become a part and parcel of modern urological practice. As a result, reoperation is rarely required unless all other resources have been exhausted. Hence the true incidence of technical graft loss due to urological complications is infrequent.