Urethroplasty in Patients With Kidney and Pancreas Transplants

No AccessJournal of UrologyAdult Urology1 Oct 2008Urethroplasty in Patients With Kidney and Pancreas Transplantsis accompanied byUrethral Reconstruction Using Oral Keratinocyte Seeded Bladder Acellular Matrix Grafts Joshua J. Meeks and Chris M. Gonzalez Joshua J. MeeksJoshua J. Meeks More articles by this author and Chris M. GonzalezChris M. Gonzalez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.06.007AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: In patients with solid organ transplants urethral strictures may develop from repeat catheterization, recurrent urinary tract infection or chronic irritation of the urethral mucosa secondary to contact with pancreatic enzymes. We describe surgical outcomes in patients with kidney and kidney-pancreas transplants after urethral reconstruction for stricture or fistula disease. Materials and Methods: Ten males underwent urethroplasty for urethral stricture (9) or urethral fistula (1) disease after kidney or kidney-pancreas transplantation. Median patient age was 41.5 years (range 25 to 56) and average time from transplantation was 9 years (range 1 to 14). Four patients underwent bulbar urethroplasty with buccal mucosa, 3 underwent stricture excision and primary anastomosis of the bulbar urethra, 2 underwent penile urethroplasty with graft tissue and 1 underwent bulbar urethrocutaneous fistula repair. Results: The etiology of stricture disease was pancreatic enzyme induced stricture in 40% of cases, catheter trauma in 40% and unknown in 20%. Nine of 10 patients (90%) were free of symptoms and recurrence at a median followup of 32.5 months (range 4 to 83). One patient who required cystoscopy and dilation for a bulbar urethral recurrence is currently disease-free. Postoperative morbidity included urinary tract infection and a perineal hematoma requiring transfusion. Conclusions: We describe the outcomes of urethral reconstruction in patients with kidney and kidney-pancreas transplantation. As in men with normal native kidney and pancreas function, urethroplasty appears to be safe and effective in this cohort. Long-term outcome data are needed to confirm these findings. References 1 : Anterior urethral strictures: etiology and characteristics. Urology2005; 65: 1055. Google Scholar 2 : Urological complications in 210 consecutive simultaneous pancreas-kidney transplants with bladder drainage. Ann Surg1993; 218: 561. Google Scholar 3 : Bladder neck contracture and urethral stricture as complications of renal transplantation. J Urol1975; 114: 688. Link, Google Scholar 4 : Augmented anastomotic urethroplasty. J Urol2007; 177: 2211. Link, Google Scholar 5 : Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology2003; 61: 1008. Google Scholar 6 : Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol2007; 177: 1803. Link, Google Scholar 7 : Extended complications of urethroplasty. Int Braz J Urol2005; 31: 315. Google Scholar 8 : Complications relating to the urinary tract associated with bladder-drained pancreatic transplantation. Br J Urol1998; 81: 219. Google Scholar 9 : Urological complications of bladder-drained pancreatic allografts. Br J Urol1998; 81: 543. Google Scholar 10 : Are wound complications after a kidney transplant more common with modern immunosuppression?. Transplantation2001; 72: 1920. Google Scholar 11 : Wound-healing complications after kidney transplantation: a prospective, randomized comparison of sirolimus and tacrolimus. Transplantation2004; 77: 1555. Google Scholar 12 : Risk factors for impaired wound healing in sirolimus-treated renal transplant recipients. Clin Transplant2007; 21: 460. Google Scholar 13 : American Urological Association symptom index in the assessment of urethroplasty outcomes. J Urol1998; 159: 1192. Link, Google Scholar Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology19 Aug 2008Urethral Reconstruction Using Oral Keratinocyte Seeded Bladder Acellular Matrix Grafts Volume 180Issue 4October 2008Page: 1417-1420 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsurethroplastypancreas transplantkidney transplanturethral strictureMetricsAuthor Information Joshua J. Meeks More articles by this author Chris M. Gonzalez More articles by this author Expand All Advertisement PDF downloadLoading ...