COMPLICATIONS RELATING TO THE URINARY-TRACT ASSOCIATED WITH BLADDER-DRAINED PANCREATIC TRANSPLANTATION

Objective To evaluate the incidence and management of the urological c omplications after bladder-drained pancreatic transplantation. Patient s and methods A retrospective study was carried out on 24 consecutive bladder-drained pancreatic transplants in 24 patients with type I insu lin-dependent diabetes mellitus, 22 with simultaneous kidney transplan ts and two of pancreas alone, over a period of 53 months. Results All 24 patients were alive within a mean followup of 26.7 months; 22 patie nts have functioning pancreatic grafts and are insulin-independent, Th e overall incidence of urological complications was 83% (20 of 24 pati ents) and 14 patients had more than one complication, The major non-in fective complication was haematuria (eleven), which was treated conser vatively, with only two patients requiring enteric conversion, One pat ient developed a duodeno-vesical fistula and lost the functioning panc reatic 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 infec tion (nine), asymptomatic persistent bacteriuria (nine), prostatitis a nd epididymitis (one), and pyelonephritis (one), all managed with appr opriate antibiotics, Three patients developed septicaemia from uroseps is and were treated successfully with antibiotics, Two patients develo ped genital warts and were treated with laser vaporization. Conclusion Although bladder drainage has significantly contributed to the increa sing success of pancreatic transplantation, urological complications a re frequent and can be serious and life-threatening. As more of these procedures are performed urologists need to be able to recognize and t reat these problems.