This meta-analysis investigates the necessity of pre-operative cystography or voiding cystourethrography (VCUG) in end-stage renal disease (ESRD) patients awaiting kidney transplantation, particularly those without prior urologic abnormalities. While detailed bladder evaluations are common in transplant assessments, the utility of invasive imaging procedures like cystography or VCUG has been questioned. These tests often reveal minimal abnormalities in oligoanuric patients with otherwise healthy bladders, whose bladder capacity typically improves post-transplant. Moreover, the diagnostic yield of such tests is low in the absence of prior urologic history.

Following PRISMA guidelines, a systematic literature review was conducted across five databases to identify comparative studies up to June 2024. Studies included compared VCUG findings in ESRD patients without previous urologic disease to those with known urologic issues, such as recurrent urinary tract infections, hydronephrosis, vesicoureteral reflux, bladder dysfunction, or prior urologic surgery.

Data from five studies revealed that only 4.8% (43 out of 902) of patients without a urologic history showed abnormal VCUG findings. In contrast, 45.4% (127 out of 280) of patients with known urologic abnormalities had abnormal results. Statistical analysis showed a significantly lower risk of abnormal findings in patients without prior urologic disease (Risk Ratio = 0.07; 95% CI 0.02–0.29; p = 0.0003).

The results suggest that routine pre-transplant VCUG may be unnecessary for ESRD patients without a history of urologic issues. Eliminating such procedures in this low-risk group could reduce healthcare costs, avoid unnecessary invasive testing, and streamline the transplant evaluation process without compromising patient safety.