Complications relating to the urinary tract associated with bladder-drained pancreatic transplantation

To evaluate the incidence and management of the urological complications after bladder-drained pancreatic transplantation.

A retrospective study was carried out on 24 consecutive bladder-drained pancreatic transplants in 24 patients with type I insulin-dependent diabetes mellitus, 22 with simultaneous kidney transplants and two of pancreas alone, over a period of 53 months.

All 24 patients were alive within a mean follow-up of 26.7 months: 22 patients have functioning pancreatic grafts and are insulin-independent. The overall incidence of urological complications was 83% (20 of 24 patients) and 14 patients had more than one complication. The major non-infective complication was haematuria (eleven), which was treated conservatively, with only two patients requiring enteric conversion. One patient developed a duodeno-vesical fistula and lost the functioning pancreatic 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 infection (nine), asymptomatic persistent bacteriuria (nine), prostatitis and epididymitis (one), and pyelonephritis (one), all managed with appropriate antibiotics. Three patients developed septicaemia from urosepsis and were treated successfully with antibiotics. Two patients developed genital warts and were treated with laser vaporization.

Although bladder drainage has significantly contributed to the increasing success of pancreatic transplantation, urological complications are frequent and can be serious and life-threatening. As more of these procedures are performed urologists need to be able to recognize and treat these problems.