Correlation of preoperative urodynamic findings to postoperative complications following pancreas transplantation

Urological complications are common following pancreas transplantation with bladder drainage. Some investigators have excluded patients from pancreas transplantation because of abnormal preoperative urodynamics. To determine the risk of an abnormal bladder in bladder-drained pancreas transplantation, we prospectively evaluated 23 type I diabetic patients undergoing pancreas transplantation with preoperative urodynamics. For study purposes, criteria for an abnormal urodynamic evaluation were a bladder capacity of greater than 1,000 cc, absence of normal detrusor contractility and an abnormal voiding pattern. In addition, an abnormal study was defined by the presence of 2 or more of the following: 1) suppressed proprioception at 250 cc or at a volume of greater than 50% of bladder capacity, 2) peak flow of less than 10 cc per second, 3) interval to peak flow of greater than 30 seconds or 4) post-void residual of greater than 150 cc. Of the 23 patients 10 (43%) had abnormal preoperative urodynamic studies. All 23 patients underwent pancreas transplantation with bladder drainage, alone or in combination with a kidney transplant. The incidence of urological complications was 3.1 and 3.4 per patient, respectively, in the normal and abnormal groups (p = 0.126). Patient and graft survival rates were similar between the 2 groups (p > 0.5). We were unable to show that abnormal preoperative urodynamic studies preclude successful pancreas transplantation with bladder drainage or predict an increase in postoperative complications.