Complications of a pancreas transplant drained into the bladder include:

A. Duodenal segment leak.

B. Recurrent urinary tract infections.

C. Recurrent hematuria.

D. Urethritis.

E. Refractory loss of bicarbonate.

DISCUSSION: All of the listed problems are potential complications of bladder drainage. The most useful diagnostic tests for a duodenal segment leak include CT cystogram and technetium-based nuclear cystogram. Cystoscopy should be performed in patients with recurrent urinary tract infections to evaluate the presence of sutures or foreign bodies acting as a nidus for infection. Severe recurrent hematuria, as well as urethritis (most commonly affecting males), may occur with bladder drainage. Finally, severe bicarbonate loss may be associated with bladder drainage, and some patients may have difficulty keeping up with the loss by oral bicarbonate replacement. All of the above situations can be effectively treated with enteric conversion