Urethroplasty in patients with kidney and pancreas transplants

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 I 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.