Patients with end-stage kidney disease on long-term dialysis often have reduced bladder capacity, complicating kidney transplantation and increasing urinary complication risks. Though recovery is possible, outcomes remain uncertain—especially in Vietnam, where data are still limited.

A retrospective study at Cho Ray Hospital (6 years: 2017–2023) included kidney transplant recipients with bladder capacity ≤100 milliliters-mL. Clinical data and 1-year outcomes (Graft function, urinary complications, bladder recovery) were analyzed and compared to those with normal bladder capacity.

A total of 122 patients with small bladder capacity (21% of transplants) were included. Mean age was 33.4 ± 8.9 years; 68.9% were male. Average dialysis duration was 41.1 ± 29.9 months; 81.1% were anuric. Mean pre-transplant bladder volume was 81.1 ± 20.1 mL. Vesicoureteral reflux occurred in 19.5% vs. 4.3% in normal-capacity patients (p < 0.05). All received living-donor kidneys; 95.9% had Lich–Gregoir ureteric implantation. Early urinary complications occurred in 8.1% (e.g., leakage 2.4%), and urinary tract infection in 10.7%. Most issues appeared within 2–3 months and resolved. At 1 year, graft and patient survival rates were 99.2% and 98.4%. Serum Creatinine improved from ~1.3 mg/dL at discharge to 1.25 ± 0.19 mg/dL at 12 months. Bladder capacity improved: voided volume ~222 mL, voiding frequency 14 times per day. Recovery time averaged 40.6 ± 27.5 days. Prolonged catheterization occurred in 11.4%; only 1.6% needed further bladder management. Most patients regained satisfactory bladder function.

Kidney transplantation in patients with small bladder capacity is feasible and yields excellent one-year outcomes. Despite higher rates of early urinary complications, bladder function improves significantly post-transplant. Proper perioperative care enables favorable results even in severe cases.