Consultation with a urologist – a physician with expertise in the urological system, which includes the kidneys, bladder, ureter, and prostate – facilitates the necessary preparations for surgery and can enhance the quality of life for transplant recipients.
“Prior to kidney transplantation, it is important to evaluate the patient’s urinary bladder,” says Mathew I. S. Whang, M.D., Director of Transplant Urology at SBMC. “Most people on dialysis do not make urine. If the bladder sits idle for many years, it can shrivel up,” he notes. An extremely small bladder cannot accommodate the urine produced by a healthy transplanted kidney.
According to Dr. Whang, techniques exist for stretching a small bladder. If atrophy of the bladder is severe, it can be reconstructed by using portions of the patient’s intestine or it can be totally replaced.
The urologist is also called upon to evaluate the transplant candidate’s diseased kidneys. Inactive kidneys should be removed if they contain stones or tumors or present a potential source of infection. Male patients over the age of 50 are also screened for prostate cancer before they can be listed as an active candidate on the transplant waiting list.
Dr. Whang participates in the transplant surgeries performed at Saint Barnabas Medical Center by executing the delicate suturing that completes the connections between the kidney, ureter and bladder. The ureter is the small tube through which urine flows from the kidney to the bladder. Having a urologist present in the operating room during transplantation also ensures that any difficulties with the urinary system that may not have been detected before surgery are managed at that time.
Although sexual dysfunction does not preclude anyone from receiving a transplant nor does it threaten the viability of a transplanted organ, it can be an important issue surrounding the patient’s quality of life. “More than 80 percent of male patients with renal disease experience some degree of sexual dysfunction,” notes Dr. Whang. Multiple factors can affect potency, including diabetes, hypertension and circulatory or neurological problems. “Before transplantation, many men with renal disease are too weak or immersed in significant health issues to address their sexual satisfaction,” explains Dr. Whang. “Once they gain a greater quality of life following transplantation, sexual dysfunction is one of the first issues they want resolved. Patients are very happy with the results achieved with available medications and prostheses.”
A significant number of male kidney transplant recipients discover when they begin urinating again after kidney transplant surgery that their prostate is enlarged. When this occurs, individuals may experience difficulty or pain when urinating. Fortunately, there are several surgical and non-surgical methods for treating an enlarged prostate.
“The transplant team has developed an effective screening process for preventing urologic complications that were at one time common with renal transplants,” says Dr. Whang. Today’s kidney recipients are enjoying richer lives with fewer concerns about their urologic health and sexual function.
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