Cystometrography provides a previously unrecognized opportunity for successful management of urinary leaks after renal transplantation

Urological complications after kidney-pancreas transplantation

PURPOSE

Urological complications are common after kidney-pancreas transplantation. Predictors of urological complication after transplantation have not been established. We studied the impact of urological complications on allograft function. In addition we evaluated age at transplantation, diabetic years before transplantation and preoperative bladder function as predictors of allograft pancreatitis, postoperative retention and urine leaks.

MATERIALS AND METHODS

Urological complications in 65 cases (38 men, 27 women, mean diabetic years 21 +/- 6, mean age 33 +/- 7 years) who had transplants between December 1987 and January 1995 were reviewed. Preoperative urodynamics in 50 patients (77%) and voiding cystourethrogram in 40 (62%) were analyzed. Kidney-pancreas transplantation was completed using bladder drainage techniques.

RESULTS

Mean followup was 44 +/- 27 months (median 40, range 1 to 93). Urological complications in 51 patients (79%) included urinary tract infection in 59%, hematuria in 26%, allograft pancreatitis in 19%, duodenal leaks in 17%, ureteral lesions in 9% and urethral lesions in 6%. Eleven duodenal leaks (8 leaks in less than 1 month) required surgical treatment. Nine leaks recurred in 7 patients. Allograft pancreatitis occurred 32 times (range 1 to 9) in 12 patients. Three patients had ureteral obstruction and 3 had ureteral leaks. Preoperative urodynamics included detrusor hyperreflexia in 8 patients, detrusor areflexia in 19, indeterminate in 5 and normal in 18. The 1-year patient, kidney and pancreatic allograft survival rates were 92, 91 and 86%; 2-year survival rates were 89, 88 and 80%, and 5-year survival rates were 61, 59 and 55%, respectively.

CONCLUSIONS

Urological complications were common after transplantation but did not adversely affect allograft survival in our series. Age at transplantation, diabetic years preceding transplantation and preoperative bladder function were not significantly correlated with allograft pancreatitis, postoperative urinary retention or urine leaks. A prospective analysis of postoperative bladder function should be completed to improve understanding and possibly reduce morbidity of urological complications after transplantation.

Urological complications of pancreatic transplantation

PURPOSE

Pancreas transplantation is increasingly being used in the treatment of type I insulin-dependent diabetes mellitus. Because bladder drainage of the exocrine pancreatic secretion is the procedure of choice, urological complications are frequent. As the number of these procedures increases the urologist will have an extended role in the management of the postoperative complications, the majority of which are urological.

MATERIALS AND METHODS

The literature from 1985 on the complications related to pancreas transplants was reviewed.

RESULTS

Approximately 50 to 60% of bladder drained pancreas transplant recipients will have a urological complication postoperatively.

CONCLUSIONS

The increasing application of bladder drained pancreas transplantation in the treatment of type I insulin-dependent diabetes mellitus necessitates that the clinical urologist is familiar with the management of complications related to this procedure.