De novo urethral stricture disease in renal transplant recipients

Abstract

Introduction: With routine catheterization and low urine output pre-transplant, renal transplant recipients (RTRs) may be at risk of urethral stricture disease post-transplant. The objective of this study was to characterize new urethral stricture disease in males following renal transplant. Methods: Retrospective chart review was carried out on all male RTRs at Vancouver General Hospital who developed urethral strictures from October 2009–2019. Descriptive analyses were conducted on patient characteristics. Comparative analyses against non-stricture RTRs were carried out. Results: Of 636 RTRs, 18 (2.8%) developed a postoperative urethral stricture. Median time from transplant to stricture discovery was 56 days (range 8–618 days). One-third of stricture patients had prior risk factors for stricture formation. Post-transplant, 77.8% presented symptomatically, with 61.1% requiring intervention. Overall graft survival rate was 88.9% among the RTR stricture group; 16.7% experienced acute rejection and 22.2% had delayed graft function (DGF). There was no significant association between developing postoperative urethral stricture and urinary tract infection (Chi-squared [X2]=0.04, p=0.84; odds ratio [OR] 0.81, 95% confidence interval [CI] 0.1–6.21), DGF (X2=0.14, p=0.70; OR 0.8, CI 0.26–2.48), or acute rejection (X2=2.02, p=0.14; OR 2.55, CI 0.71–9.12). Conclusions: De novo post-transplant urethral stricture rates appear to occur at a higher rate than the general population and contribute to patient morbidity. Stricture disease should be considered post-transplantation in patients with voiding dysfunction, even if they don’t have prior risk factors. Multicenter studies should be considered to elucidate any relationship between urethral stricture and graft survival.