finding on a CT or MRI), we favor nephrectomy to establish the diagnosis. The procedure is usually well tolerated; in contrast a biopsy can be difficult to perform, and this often fails to provide a definitive diagnosis.

Cystoscopy is recommended when persistent hematuria is documented without clear etiology, as well as in the setting of recurrent infection. Removal of retained suture material is occasionally necessary; this can be safely accomplished via the cystoscope. Additionally, endoscopic evaluation of the urethra and stricture dilation is often comfortably performed in the outpatient setting.

Prostatic resections, usually for benign hypertrophy, have become more common as the transplant recipient population has aged. We favor aggressive application of this procedure to avoid irreversible obstructive damage to the renal transplant.

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