Early Operative Intervention for Urologic Complications of Kidney‐Pancreas Transplantation

Abstract

Bladder drainage of exocrine secretions during pancreas transplantation can be associated with significant complications. We present a proactive approach to these complications consisting of early cystoenteric conversion (CEC). Although 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabolic acidosis. There were 13 patients who presented with a urine leak: 12 with acute abdominal pain, and 1 asymptomatic. Serum amylase and creatinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interval to CEC ranged from 2 to 45 months. One patient died of fungal sepsis. Postoperative complications included duodenojejunal anastomotic bleed (n = 1), negative relaparotomy (n = 1), myocardial infarction (n = 1), graft pancreatitis (n = 1), and wound infection (n = 1). Twelve patients presented with other complications: three women with cystitis (n = 2) or hematuria (n = 1), and nine men with urethritis (n = 6), scrotal edema (n = 2), or dysuria (n = 1), The interval to conversion ranged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were significantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak-associated mortality was 7.7%, morbidity 38.5%, and graft salvage rate 92.3%. For other complications the mortality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a safe, effective treatment for urologic complications of pancreas transplantation. Morbidity and mortality were acceptable; admissions and hospital days were decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures for management of urologic complications of pancreatic transplantation.

Fístulas Duodenais Tardias Em Transplante Pancreático Com Drenagem Vesical Tratadas Sem Conversão

“…10 Tradicionalmente as fístulas precoces são tratadas inicialmente com descompressão vesical por cateterismo de demora, enquanto as fístulas tardias são indicação da conversão da drenagem vesical para drenagem entérica, tratamento da infecção por citomegalovírus, se indicado, e ressecção da área isquêmica duodenal. 4,7,11 Tendo sido observada na literatura a melhora dos sintomas das fístulas tardias com a instalação de cateterismo de demora com cateter de Foley 5,6,8 . A manutenção da cateterização por oito semanas na tentativa de fechamento espontâneo parece lógico 12 , mesmo em casos de fístula tardia.…”

Perioperative treatment with octreotide minimizes technical complications after enteric conversion of bladder‐drained pancreas transplants

“…The alternative method of pancreatic drainage is BD. This strategy has been associated with a lower rate of surgical infection compared with entero–entero anastomosis, which enables the monitoring of urinary amylase for rejection, permits easy control of anastomotic complications by decompression with urethral catheter drainage and allows trans‐cystoscopic allograft biopsy (11, 21).…”

“…Although graft and patient survival rates are comparable in the ED and BD groups of patients, the latter seems to have slightly reduced technical failure rates (1). Nevertheless, the obligatory fluid and bicarbonate losses into the urine may provoke dehydration, alterations in the normally acidic, enzyme‐free environment of the lower urinary tract, and result in unique metabolic and urological complications such as leak, urethritis, hematuria, recurrent urinary tract infections, and reflux pancreatitis (6–8, 10, 21, 22). These complications are often self‐limiting, can be managed non‐operatively, and usually tend to resolve within 6 months after PTx (22).…”

Role of the Interventional Radiologist in Pancreatic Whole Organ and Islet Cell Transplantation

“…14,15 This is the least common technique and has fallen out of favor due to risks of metabolic acidosis, recurrent cystitis, and other urinary tract complications. 16 Enteric drainage of the pancreas is most common, accounting for over 90% of the patients undergoing SPK in 2010. 13 Following creation of anastomoses, a drain is placed near the pancreas to capture any persistent bleeding or leakage.…”