Complications relating to the urinary tract associated with bladder‐drained pancreatic transplantation

Objective  To evaluate the incidence and management of the urological complications after bladder‐drained pancreatic transplantation. Patients and methods  A retrospective study was carried out on 24 consecutive bladder‐drained pancreatic transplants in 24 patients with type I insulin‐dependent diab...

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Bibliographic Details
Published in:British Journal of Urology 1998-02, Vol.81 (2), p.219-223
Main Authors: BAKTAVATSALAM, R, LITTLE, D. M, CONNOLLY, E. M, FARRELL, J. G, HICKEY, D. P
Format: Article
Language:English
Subjects:
Adult
Anastomosis, Surgical - adverse effects
Anastomosis, Surgical - methods
Bacteriuria - etiology
Biological and medical sciences
Diabetes Mellitus, Type 1 - surgery
duodenovesical fistula
Duodenum - surgery
Female
haematuria
Humans
Kidney Transplantation
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Middle Aged
Pancreas Transplantation - adverse effects
Pancreas Transplantation - methods
Pancreatic transplantation
Recurrence
Retrospective Studies
Sepsis - etiology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Surgery of the urinary system
urethral stricture
urethritis
Urinary Bladder - surgery
Urinary Tract Infections - etiology
Urologic Diseases - etiology
urosepsis
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Summary:Objective  To evaluate the incidence and management of the urological complications after bladder‐drained pancreatic transplantation. Patients and methods  A retrospective study was carried out on 24 consecutive bladder‐drained pancreatic transplants in 24 patients with type I insulin‐dependent diabetes mellitus, 22 with simultaneous kidney transplants and two of pancreas alone, over a period of 53 months. Results  All 24 patients were alive within a mean follow‐up of 26.7 months; 22 patients have functioning pancreatic grafts and are insulin‐independent. The overall incidence of urological complications was 83% (20 of 24 patients) and 14 patients had more than one complication. The major non‐infective complication was haematuria (eleven), which was treated conservatively, with only two patients requiring enteric conversion. One patient developed a duodenovesical fistula and lost the functioning pancreatic graft as a consequence. Other non‐infective complications were urethritis (one) and urethral stricture (one), which were managed with catheter drainage and internal urethrotomy, respectively, and vulval ulcers (one) and reflux pancreatitis (one) treated conservatively. The main infective complications were recurrent lower urinary tract infection (nine), asymptomatic persistent bacteriuria (nine), prostatitis and epididymitis (one), and pyelonephritis (one), all managed with appropriate antibiotics. Three patients developed septicaemia from urosepsis and were treated successfully with antibiotics. Two patients developed genital warts and were treated with laser vaporization. Conclusion  Although bladder drainage has significantly contributed to the increasing success of pancreatic transplantation, urological complications are frequent and can be serious and life‐threatening. As more of these procedures are performed urologists need to be able to recognize and treat these problems.
ISSN:0007-1331
1464-410X
DOI:10.1046/j.1464-410X.1998.00517.x