Kiaran O'Malley

Urological Complications of Pancreatic Transplantation

PURPOSE Pancreas transplantation is increasingly being used in the treatment of type I insulin-dependent diabetes mellitus. Because bladder drainage of the exocrine pancreatic secretion is the procedure of choice, urological complications are frequent. As the number of these procedures increases the urologist will have an extended role in the management of the postoperative complications, the majority of which are urological. MATERIALS AND METHODS The literature from 1985 on the complications related to pancreas transplants was reviewed. RESULTS Approximately 50 to 60% of bladder drained pancreas transplant recipients will have a urological complication postoperatively. CONCLUSIONS The increasing application of bladder drained pancreas transplantation in the treatment of type I insulin-dependent diabetes mellitus necessitates that the clinical urologist is familiar with the management of complications related to this procedure.

Renal transplantation in patients with an augmentation cystoplasty

Objective To retrospectively review our experience over a 10‐year period of renal transplantation in patients with augmented bladders and thus assess the safety of this procedure.

Secondary hypospadias repair in two stages.

INTRODUCTION Following failed primary reconstruction, various single-stage reconstructive techniques have been proposed for secondary hypospadias repair. Unfortunately, these frequently fail to achieve a satisfactory cosmetic and functional outcome. We review a single surgeons experience of two-staged reconstruction in this scenario. PATIENTS AND METHODS Of 104 patients with hypospadias treated in two stages, between July 1998 and June 2003, 42 were secondary reconstructions. The site of the meatus after initial failed repair was glanular (5), subcoronal (11), distal shaft (12), mid-shaft (6) or peno-scrotal (8). Factors associated with the choice of two-stage reconstruction included moderate/severe chordee (14), excessive scarring (15), shallow/no groove or poor glans (8), and balanitis xerotica obliterans (4). The grafts used were post-auricular skin (PAWG, 29) buccal mucosa (BMG, 6), inner prepuce (IP, 6) and one composite graft. The mean age of our patients was 131 months and the average follow up after the second stage was 26.3 months. RESULTS In 40 of the 42 cases the graft took well. In one patient a PAWG developed keloid scarring which was excised and later successfully replaced with a BMG. In another, severe shrinkage of a BMG led to revision with a PAWG. Following the second stage, complications were experienced in five: the repair broke down in two BMG patients and was successfully reconstructed with a PAWG in both, and three developed fistulae that were repaired (1 PAWG, 1 BMG, 1 IP). CONCLUSIONS The two-staged reconstruction is a versatile and technically straightforward secondary procedure for this difficult patient cohort. Excellent cosmetic and functional results can be achieved with only a small risk of a revision operation. Four of our six BMG patients experienced problems and PAWG appears more satisfactory with superior results.