Endoscopic treatment of bladder outlet obstruction in men after pancreas transplantation

Diabetic cystopathy comprises a spectrum of voiding dysfunction. The usual clinical manifestations are impaired bladder sensation and detrusor contractility. Diabetic cystopathy is present in as many as 43 to 85% of patients undergoing pancreas transplantation. We evaluated endoscopic management of bladder outlet obstruction for adjuvant treatment of urological complications after pancreas transplantation.

We evaluated 10 men with recurrent urological complications, including bladder leak, urinary tract infection, the dysuria/urethritis syndrome and reflux nephropathy, after pancreas transplantation. Evaluation consisted of peak flow rate, post-void residual and written questionnaires in all cases, and preoperative urodynamics in 2. All patients had signs and symptoms of bladder outlet obstruction at post-transplant presentation and underwent bladder neck incision, direct visual internal urethrotomy, limited transurethral resection of the bladder neck or transurethral resection of the prostate. Hospital costs, including operating room, laboratory, pharmacy, hospital room occupancy, anesthesia and radiology fees, were obtained from the University of Washington.

Mean peak flow rate plus or minus standard deviation increased from 10.1+/-3.2 to 21.0+/-5.1 cc per second and post-void residual decreased from 259.2+/-38.6 to 43.6+/-36.8 cc after endoscopic intervention. Of the patients 4 presented early (mean 4.3 months) after transplantation with bladder leak or reflux nephropathy, while late presentation (mean 43 months) was associated with recurrent urinary tract infection, the urethritis/dysuria syndrome and more obstructive symptoms. Complications resolved in all cases after surgery and enteric conversion, which costs 5-fold more than endoscopic intervention, was avoided.

Recurrent urological complications warrant early evaluation for occult bladder dysfunction. Endoscopic procedures to relieve outlet obstruction are beneficial in alleviating recurrent urological complications in men after pancreas transplantation. This cost-effective and low morbidity procedure may obviate the need for enteric conversion in some male transplant recipients.