Gettman M T, Levy J B, Engen D E, Nehra A
Department of Urology, Mayo Clinic Foundation, Rochester, Minnesota, USA.
J Urol. 1998 Jan;159(1):38-42; discussion 42-3. doi: 10.1016/s0022-5347(01)64005-9.
Urological complications are common after kidney-pancreas transplantation. Predictors of urological complication after transplantation have not been established. We studied the impact of urological complications on allograft function. In addition we evaluated age at transplantation, diabetic years before transplantation and preoperative bladder function as predictors of allograft pancreatitis, postoperative retention and urine leaks.
Urological complications in 65 cases (38 men, 27 women, mean diabetic years 21 +/- 6, mean age 33 +/- 7 years) who had transplants between December 1987 and January 1995 were reviewed. Preoperative urodynamics in 50 patients (77%) and voiding cystourethrogram in 40 (62%) were analyzed. Kidney-pancreas transplantation was completed using bladder drainage techniques.
Mean followup was 44 +/- 27 months (median 40, range 1 to 93). Urological complications in 51 patients (79%) included urinary tract infection in 59%, hematuria in 26%, allograft pancreatitis in 19%, duodenal leaks in 17%, ureteral lesions in 9% and urethral lesions in 6%. Eleven duodenal leaks (8 leaks in less than 1 month) required surgical treatment. Nine leaks recurred in 7 patients. Allograft pancreatitis occurred 32 times (range 1 to 9) in 12 patients. Three patients had ureteral obstruction and 3 had ureteral leaks. Preoperative urodynamics included detrusor hyperreflexia in 8 patients, detrusor areflexia in 19, indeterminate in 5 and normal in 18. The 1-year patient, kidney and pancreatic allograft survival rates were 92, 91 and 86%; 2-year survival rates were 89, 88 and 80%, and 5-year survival rates were 61, 59 and 55%, respectively.
Urological complications were common after transplantation but did not adversely affect allograft survival in our series. Age at transplantation, diabetic years preceding transplantation and preoperative bladder function were not significantly correlated with allograft pancreatitis, postoperative urinary retention or urine leaks. A prospective analysis of postoperative bladder function should be completed to improve understanding and possibly reduce morbidity of urological complications after transplantation.
肾胰联合移植术后泌尿系统并发症很常见。移植术后泌尿系统并发症的预测因素尚未明确。我们研究了泌尿系统并发症对移植器官功能的影响。此外，我们评估了移植时的年龄、移植前糖尿病病程以及术前膀胱功能作为移植器官胰腺炎、术后尿潴留和尿漏的预测因素。
回顾了1987年12月至1995年1月期间进行移植的65例患者（38例男性，27例女性，平均糖尿病病程21±6年，平均年龄33±7岁）的泌尿系统并发症情况。分析了50例患者（77%）的术前尿动力学检查结果以及40例患者（62%）的排尿性膀胱尿道造影结果。肾胰联合移植采用膀胱引流技术完成。
平均随访时间为44±27个月（中位数40个月，范围1至93个月）。51例患者（79%）出现泌尿系统并发症，其中尿路感染占59%，血尿占26%，移植器官胰腺炎占19%，十二指肠漏占17%，输尿管病变占9%，尿道病变占6%。11例十二指肠漏（8例发生在1个月内）需要手术治疗。7例患者出现9次漏复发。12例患者发生移植器官胰腺炎32次（范围1至9次）。3例患者出现输尿管梗阻，3例出现输尿管漏。术前尿动力学检查结果显示，8例患者为逼尿肌反射亢进，19例为逼尿肌无反射，5例结果不确定，18例正常。患者、肾脏和胰腺移植器官的1年生存率分别为92%、91%和86%；2年生存率分别为89%、88%和80%，5年生存率分别为61%、59%和55%。
移植术后泌尿系统并发症很常见，但在我们的研究系列中对移植器官存活没有不利影响。移植时的年龄、移植前糖尿病病程以及术前膀胱功能与移植器官胰腺炎、术后尿潴留或尿漏无显著相关性。应完成对术后膀胱功能的前瞻性分析，以增进了解并可能降低移植术后泌尿系统并发症的发病率。
