Cystoenteric conversion and reduction cystoplasty for treatment of bladder dysfunction after pancreas transplantation.
OBJECTIVE
Bladder drainage of pancreatic exocrine secretions during pancreas transplantation can lead to significant urological complications. Our experience with cystoenteric conversion (CEC) is reviewed with respect to safety and efficacy. Select patients underwent concurrent reduction cystoplasty.


METHODS
A total of 255 pancreas transplantations were performed at the University of Washington between 1990 and 2001, of which 236 were bladder drained and 33 required enteric conversion of bladder drainage. An additional patient from an outside institution required conversion. These cases were reviewed retrospectively. Of the patients 21 with large capacity (greater than 500 ml) bladders underwent concurrent reduction cystoplasty.


RESULTS
Mean age of the 20 male and 14 female patients was 44 years (range 33 to 60) and mean interval between transplantation and CEC was 4.3 years (0.6 to 9). The most frequent indication for CEC was recurrent urinary tract infections (15 of 34 cases, 44%). Mean followup after CEC was 2.5 years (range 0.3 to 6.5). Six complications requiring reoperation were seen in 5 of the 34 patients (15%), one of which led to death (3%). Normal pancreatic graft function persisted in 30 of the 34 cases (88%). After reduction cystoplasty mean bladder capacity in all 34 cases decreased from 900 to 465 ml intraoperatively (p <0.0001) and from 650 to 362 ml in 9 according to urodynamics (p <0.015). Of the patients 30 (88%) experienced resolution of symptoms, while 3 (9%) experienced improvement and 1 (3%) continued to have recurrent infections.


CONCLUSIONS
Although we advocate maximal conservative treatment of the urological complications of pancreas transplantation, CEC offers safe and effective management of these complications, and can easily be combined with reduction cystoplasty in select cases to optimize postoperative voiding function.
Black
Peter C
PC
Department of Urology, University of Washington, Seattle, WA, USA.
Plaskon
Lora A
LA
Miller
Jane
J
Bakthavatsalam
Ramasamy
R
Kuhr
Christian S
CS
Marsh
Christopher L
CL
D000328:Adult; D003559:Cystostomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D010189:Pancreatic Juice; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013536:Suture Techniques; D001743:Urinary Bladder / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology