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Urological complications of bladder‐drained pancreatic allografts
Author(s) -
Del Pizzo,
Jacobs,
Bartlett,
Sklar
Publication year - 1998
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1046/j.1464-410x.1998.00619.x
Subject(s) - medicine , surgery , pancreatitis , pancreas transplantation , transplantation , urinary fistula , fistula , pancreas , urinary system , urinary bladder , kidney transplantation
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.