Urological complications of bladder-drained pancreatic allografts.
OBJECTIVE
To examine the spectrum of urological complications associated with bladder drainage of pancreatic allografts.


METHODS
Between July 1991 and October 1996, 140 consecutive bladder-drained pancreatic allografts were performed and were reviewed retrospectively to determine the spectrum of post-operative urological complications. Ninety-five patients (68%) underwent simultaneous pancreas-kidney transplantation, 35 (25%) had the pancreas transplanted after the kidney, while 10 (7%) had a pancreas transplant alone. The mean follow-up was 35 months.


RESULTS
Seventy patients (50%) had urological complications necessitating intervention: 17 (12%) had retained foreign bodies, bladder tumours occurred in three, 14 had bladder calculi and 15 (11%) had cystoscopic evidence of duodenitis. One patient developed an arteriovenous fistula and one had a necrotic duodenal allograft. Reflux pancreatitis occurred in six patients. Other complications included urethral stricture (three), urethral erosion (three), epididymitis (three), acute prostatitis (one) and prostatic abscess (one). One patient developed a urethrocutaneous fistula and another developed a vesicocutaneous fistula. In the series, 30 of the 140 patients (21%) required eventual conversion to enteric drainage of their allograft as definitive therapy.


CONCLUSIONS
Pancreatic transplantation with bladder drainage is associated with a wide range of significant urological problems. Although appropriate treatment can resolve most of the complications, this often entails additional operative intervention, which may increase the long-term morbidity or jeopardize graft function. As a result of the severity of these urological complications, some centres use primary enteric drainage as the method of choice for pancreatic transplantation.
Del Pizzo
J J
JJ
Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
Jacobs
S C
SC
Bartlett
S T
ST
Sklar
G N
GN
D001437:Bacteriuria / Q000209:etiology; D004322:Drainage / Q000009:adverse effects; D004382:Duodenitis / Q000209:etiology; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D010149:Postoperative Pain / Q000209:etiology; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D012611:Scrotum; D014184:Transplantation, Homologous; D001743:Urinary Bladder; D001744:Urinary Bladder Calculi / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology; D014570:Urologic Diseases / Q000209:etiology*