Titre du document / Document title

Complicaciones urológicas en el transplante reno-pancreático. Comentario = Urological complications in kidney/pancreas transplantation. Commentary

Auteur(s) / Author(s)

DRES. MARTINEZ P. ⁽¹⁾ ; GIUDICE C. ⁽¹⁾ ; GUEGLIO G. ⁽¹⁾ ; DAMIA O. ⁽¹⁾ ; HYON Sung Ho ⁽²⁾ ; PEKOLJ J. ⁽²⁾ ; ARGIBAY P. ^{(2 3)} ; PUSCINSKI Alberto José (Commentateur) ⁽⁴⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Servicio de Urología, Hospital Italiano de Buenos Aires, Gascón 450, (1181) Buenos Aires, ARGENTINE
⁽²⁾ Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Gascón 450, (1181) Buenos Aires, ARGENTINE
⁽³⁾ Programa de Transplante Renopancreático, Hospital Italiano de Buenos Aires, Gascón 450, (1181) Buenos Aires, ARGENTINE
⁽⁴⁾ U.N.B.A.

Résumé / Abstract

Introduction: Simultaneous Kidney/Pancreas Transplantation (KPT) is the best treatment option for type 1 diabetic patients in end stage renal disease. The implanted pancreas protects the transplanted kidney against the diabetic nephropathy. A controversial issue is the derivation of the exocrine secretion of the pancreas. The first option is the bladder drainage and the objective of the presentation is to review the urological complications in our first 10 patients. Material and Methods: Between October 1994 and May 1999, 10 simultaneous KPT were done at the Hospital Italiano de Buenos Aires. The age at the time of transplantation was 34,1 years, three men and 7 women. The median follow-up was 16, 7 months (2-41 mo.). The 1 year patient, kidney and pancreatic allograft survival rates were 79, 68, and 79% respectively. Both organs were implanted in the peritoneal cavity and we used a duodenal-bladder anastomosis (2 layers absorbible running suture). Results: Nine of the ten patients developed urological complications and there were seventeen episodes of urinary tract infection in 9 patients. Four patients had six episodes of hematuria, 1 patient had purulent pielonephritis and 2 had a reflux pancreatitis. Delay duodeno-pancreatic leak occur in 3 patients, urethral disruption in 1 and linphocele in 2 patients. One patient had two episodes of bladder stones. We did not have any complications with the ureteroneocistostomy and we did not have to perform any conversion of exocrine secretions from bladder to the enteric drainage. Conclusions: ○ Bladder drainage of the exocrine secretion of the pancreas determines urologic complications. A very close follow-up of the urologic team is needed to manage them. ○ Urologic complications can occur at any time after the transplantation but are more frequent in the first three months. ○ High bladder pressure favors reflux pancreatitis, urinary fistula and irritative voiding symptoms. ○ In every patient with sudden abdominal pain and/or hiperamilasemia a Foley bladder catheter is mandatory. ○ Fistulas were the complications with worse prognosis, and abdominal pain was the more common symptom.

Revue / Journal Title

Revista argentina de urología   ISSN 0327-3326 

Source / Source

2001, vol. 66, n^o1, pp. 12-20 (19 ref.)

Langue / Language

Espagnol

Editeur / Publisher

Sociedad Argentina de Urología, Buenos Aires, ARGENTINE  (1990) (Revue)

Mots-clés anglais / English Keywords

Transplantation ; Kidney ; Pancreas ; Human ; Homograft ; Concurrent ; Urinary system disease ; Complication ; Postoperative ; Retrospective ; Risk factor ; Clinical form ; Treatment ; Prognosis ; Surgery ;

Mots-clés français / French Keywords

Transplantation ; Rein ; Pancréas ; Homme ; Homogreffe ; Simultané ; Appareil urinaire pathologie ; Complication ; Postopératoire ; Rétrospective ; Facteur risque ; Forme clinique ; Traitement ; Pronostic ; Chirurgie ;

Mots-clés espagnols / Spanish Keywords

Trasplantación ; Riñón ; Páncreas ; Hombre ; Homoinjerto ; Simultáneo ; Aparato urinario patología ; Complicación ; Postoperatorio ; Retrospectiva ; Factor riesgo ; Forma clínica ; Tratamiento ; Pronóstico ; Cirugía ;

Localisation / Location

INIST-CNRS, Cote INIST : 26468, 35400009779613.0020