H

1. Prospective Renal Transplant
Recipient
Sureshkumar

2. • 32yr male factory worker, resident of
Kanchipuram known case of HTN since 3yrs
and CKD since 1 year
• Native kidney disease – Not knwon
• Prospective donor- Wife 30y/F
• h/o dysuria, hesitancy, incomplete emptying+
• h/o hematuria 1 yr back managed
conservatively outside hospital.

3. • On MHD since 1 yr- (@ Kanchipuram GH) 3/7
• Daily output-15-30ml
• Not a k/c/o DM/TB/BA
• No similar history in family.
• Married – 2 children

4. • Past history-
• H/O ? b/l (Cohen’s)ureteric reimplantation in
April 1993 for b/l Megaureter
• H/O PUV endoscopic ablation/ fulguration in
July 1997
• H/O B/L (modified lead better politano)
ureteric reimplantation in Aug 1997
• H/O Check cystoscopy in Oct1997-Normal

5. • Patient lost to follow up for 5 yrs and again
presented with UTI (2005)
• Uroflowmetry+ PVR done :
• Voided vol- 617ml
• Peak flow – 23/sec
• PVR- 600ml
• Cystoscopy done s/o: Grade3 trabeculations and
bladder capacity-600ml
• Adviced:- Double and triple voiding

6. • In 2006 again he presented with similar
complaints and diagnosed as Valve bladder
syndrome and advice for CIC daily.
• Patient gave up CIC after few years.
• H/O admission for Acute pulmonary edema &
was intubated and managed conservatively in
sep 21.

7. • Vascular access left BC AVF
• PA- lower abdominal transverse scar +, SPC
scar+ , Peripheral pulses well felt
• RS,CNS, CVS - NAD
• Genitals-Normal Meatus, B/L testis palpable
Normal
• DRE- Tone-lax, BCR-,Flat prostate

8. • Hb-14.3
• Creat-14.5
• K-6.3
• Urine c/s: -ve
• TFT- Normal

9. • USG-: B/L medical renal disease
RK- 9.5x4.5cm CMD-lost
LK-10x4.6cm, CMD-lost, PCS-mildly dilated.
• X-ray voiding cystourethrogram-
B/L VUR , RIGHT GRADE-IV & LEFT GRADE-V
With Neurogenic bladder with cystitis
Significant PVR.

10. • CT KUB-
RK- 8.1x3.6cm
LK-9.6x3.6cm
B/L PCS is grossly dilated with cortical thinning
• Note made of anterior-superior insertion of
left ureter and postero-superior insertion of
right ureter into bladder.
• Iliac vessel doppler- Normal

11. • Uroflowmetry-
• Max flow-1ml/s
• Voided volume-59ml

16. Cystoscopy
• Patient underwent Diagnostic cystoscopy + RGP +
Bladder biopsy on 5.01.2023
• Findings:- Meatus, Urethra – Normal, prostate-
non occlusive, Bladder neck mild elevation +,
Grade 2-3 trabeculations noted.
• B/L neo-ureteric orifice noted 2cm above and
lateral to native ureteric orifice, through which
guide wire passed and RGP done- grossly dilated
b/l PCS noted.Cytitis changes noted in bladder
biopsy taken (HPE- No e/o atypia noted).

17. • Bladder capacity- 250ml
• Wardills test +ve.
• Patient had hematuria post operatively so
3way 20fr folye’s was inserted and irrigations
started.

21. • UDE- 1997
• Pressure flow :- Incomplete emptying ?due to
underactive detrusor activity
• Impression CMG :- Stable detrusor with
sensory urgency.
• Voiding detrusor pressure- 30cm H2O
• Cystometry:-Bladder capacity
>350ml,detrusor stable and no leakage noted.

22. • Initial flow:-
• Voided vol- 164ml
• Residual -165ml
• Max flow rate- 11.5ml/sec
• Voiding time- 27seconds