Urologic aspects of kidney-pancreas transplantation

Management of de novo nonneurogenic detrusor-sphincter dyscoordination in a bladder-drained pancreas and kidney transplantation case

Pancreas transplantation is associated with significant urological complications. Urological complications can jeopardize the graft survival. We present a de novo nonneurogenic detrusor-sphincter dyscoordination in a pancreas and kidney transplanted case. We also report follow-up under conservative treatment.

Urethral stricture after pancreas-kidney transplantation due to polypoid urethritis

Urologic complications are common after pancreas-kidney transplantation using bladder drainage. We report a case of urethral stricture caused by polypoid urethritis occurring 4 years after simultaneous pancreas-kidney transplantation. Endoscopic exploration revealed irregular, ragged-appearing urethral mucosa. The diagnosis of polypoid urethritis was confirmed histopathologically.

Cystoenteric Conversion and Reduction Cystoplasty for Treatment of Bladder Dysfunction After Pancreas Transplantation

PURPOSE

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.

MATERIALS AND 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.