UROLOGICAL COMPLICATIONS OF BLADDER-DRAINED PANCREATIC ALLOGRAFTS

Objective To examine the spectrum of urological complications associat ed with bladder drainage of pancreatic allografts, Patients and method Between July 1991 and October 1996, 140 consecutive bladder-drained p ancreatic allografts were performed and were reviewed retrospectively to determine the spectrum of past-operative urological complications, Ninety-fi cie patients (68%) underwent simultaneous pancreas-kidney tr ansplantation, 35 (25%) had the pancreas transplanted after the kidney , while 10 (7%) had a pancreas transplant alone. The mean follow-up wa s 35 months. Results Seventy patients (50%) had urological complicatio ns necessitating intervention: 17 (12%) had retained foreign bodies, b ladder tumours occurred in three, 14 had bladder calculi and 15 (11%) had cystoscopic evidence of duodenitis. One patient developed an arter iovenous fistula and one had a necrotic duodenal allograft. Reflux pan creatitis occurred in six patients. Other complications included ureth ral stricture (three), urethral erosion (three), epididymitis (three), acute prostatitis tone) and prostatic abscess tone), One patient deve loped a urethrocutaneous fistula and another developed a vesicocutaneo us fistula, In the series, 30 of the 140 patients (21%) required event ual conversion to enteric drainage of their allograft as definitive th erapy. Conclusions Pancreatic transplantation with bladder drainage is associated with a wide range of significant urological problems. Alth ough appropriate treatment can resolve most of the complications, this often entails additional operative intervention, which may increase t he long-term morbidity or jeopardize graft function. As a result of th e severity of these urological complications, some centres use primary enteric drainage as the method of choice for pancreatic transplantati on.