Urological complications of bladder-drained pancreatic allografts

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Abstract

Objective

To examine the spectrum of urological complications associated with bladder drainage of pancreatic allografts.

Patients and method

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.

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