Bladder cycling pretransplant offers no clinical advantage in patients with defunctionalized bladder

For patients with defunctionalized bladder, bladder cycling prior to renal transplant does little to improve outcomes such as postoperative urological complication, urodynamic criteria, and graft function and survival, according to a study.

The study included 43 renal transplant candidates with defunctionalized bladder. They were randomly assigned to undergo programmed bladder cycling before transplant (n=23) or renal transplant without bladder cycling (control; n=20).

The primary endpoint was an improvement in post-transplant bladder capacity. Secondary endpoints included early urological complications, 3-month voiding function, and 1-year graft function and survival. Graft function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation.

Mean bladder capacity at baseline was 88.7 ml in the bladder cycling group and 90.6 ml in the control group (p=0.5). Of note, bladder cycling improved bladder capacity to 194.7 ml (p<0.001). Nineteen (82.6 percent) patients achieved targeted bladder capacity, while two developed urinary tract infection.

At 3 months, both the bladder cycling and control groups had significantly better bladder capacity, compliance, and bladder contractility index relative to baseline, with a marked reduction in maximum detrusor pressure. These improvements were comparable in the two groups (p=0.3, p=0.4, p=0.2, and p=0.8, respectively).

One patient in the bladder cycling group and three in the control group experienced urinary leakage (4.3 percent vs 15 percent; p=0.2). At 1 year, the two groups had similar median serum creatinine (p=0.05) and eGFR (p=0.07).