Endoscopic treatment of bladder outlet obstruction in men after pancreas transplantation

Purpose: Diabetic cystopathy comprises a spectrum of voiding dysfunction. T he usual clinical manifestations are impaired bladder sensation and detruso r contractility. Diabetic cystopathy is present in as many as 43 to 85% of patients undergoing pancreas transplantation. We evaluated endoscopic manag ement of bladder outlet obstruction for adjuvant treatment of urological co mplications after pancreas transplantation. Materials and Methods: We evaluated 10 men with recurrent urological complications, inclu ding bladder leak, urinary tract infection, the dysuria/urethritis syndrome and reflux nephropathy, after pancreas transplantation. Evaluation consist ed of peak flow rate, post-void residual and written questionnaires in all cases, and preoperative urodynamics in 2. All patients had signs and sympto ms of bladder outlet obstruction at post-transplant presentation and underw ent bladder neck incision, direct visual internal urethrotomy, limited tran surethral resection of the bladder neck or transurethral resection of the p rostate. Hospital costs, including operating room, laboratory, pharmacy, ho spital room occupancy, anesthesia and radiology fees, were obtained from th e University of Washington. Results: Mean peak flow rate plus or minus standard deviation increased fro m 10.1 +/- 3.2 to 21.0 +/- 5.1 cc per second and post-void residual decreas ed from 259.2 +/- 38.6 to 43.6 +/- 36.8 cc after endoscopic intervention. O f the patients 4 presented early (mean 4.3 months) after transplantation wi th bladder leak or reflux nephropathy, while late presentation (mean 43 mon ths) was associated with recurrent urinary tract infection, the urethritis/ dysuria syndrome and more obstructive symptoms. Complications resolved in a ll cases after surgery and enteric conversion, which costs 5-fold more than endoscopic intervention, was avoided. Conclusions: Recurrent urological complications warrant early evaluation fo r occult bladder dysfunction. Endoscopic procedures to relieve outlet obstr uction are beneficial in alleviating recurrent urological complications in men after pancreas transplantation. This cost-effective and low morbidity p rocedure may obviate the need for enteric conversion in some male transplan t recipients.