Abstract
Background
We analyzed long-term changes in the renal function of patients undergoing radical cystectomy and urinary diversion (UD).
Methods
This study included 169 patients who underwent radical cystectomy and UD (42, cutaneous ureterostomy; 40, ileal conduit; 87, neobladder substitution), and were followed for at least 60 months (median 106 months). Renal deterioration was defined as a >25 % decrease in the estimated glomerular filtration rate (eGFR) relative to that prior to surgery. We determined the associations between several parameters and postoperative renal deterioration.
Results
Despite the significantly younger age and more favorable renal function of patients with neobladder substitution than of those with other types of UD, no significant differences were observed in the remaining preoperative clinical parameters among the three different UD groups. The mean eGFR of the 169 patients decreased from 69.6 to 55.9 mL/min/1.73 m2, and renal deterioration was observed in 24 (57.1 %), 20 (50.0 %) and 34 (39.0 %) patients in the cutaneous ureterostomy, ileal conduit and neobladder substitution groups, respectively. Multivariate analysis of several parameters identified the presence of baseline hypertension and an episode of acute pyelonephritis, but not the type of UD, as significant predictors of postoperative renal deterioration.
Conclusions
The incidence of renal deterioration was comparatively high following radical cystectomy, irrespective of the type of UD. Special attention should be paid to the long-term preservation of renal function in these patients, particularly those with hypertension and/or episodes of acute pyelonephritis.
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References
Stamatakis L, Godoy G, Lerner SP (2012) Innovations in radical cystectomy and pelvic lymph node dissection. Semin Oncol 39:573–582
Takada N, Abe T, Shinohara N et al (2012) Peri-operative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan. BJU Int 110:E756–E764
Svatek RS, Fisher MB, Matin SF et al (2010) Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol 183:929–934
Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305
Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740
Shimko MS, Tollefson MK, Umbreit EC et al (2011) Long-term complications of conduit urinary diversion. J Urol 185:562–567
Madersbacher S, Schmidt J, Eberle JM et al (2003) Long-term outcome of ileal conduit diversion. J Urol 169:985–990
Hautmann RE, Volkmer BG, Schumacher MC et al (2006) Long-term results of standard procedures in urology: the ileal neobladder. World J Urol 24:305–314
Yang WJ, Cho KS, Rha KH et al (2006) Long-term effects of ileal conduit urinary diversion on upper urinary tract in bladder cancer. Urology 68:324–327
Thoeny HC, Sonnenschein MJ, Madersbacher S et al (2002) Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term? J Urol 168:2030–2034
Jin XD, Roethlisberger S, Burkhard FC et al (2012) Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol 61:491–497
Fontaine E, Leaver R, Woodhouse CR (2000) The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up. BJU Int 86:195–198
Samuel JD, Bhatt RI, Montague RJ et al (2006) The natural history of postoperative renal function in patients undergoing ileal conduit diversion for cancer measured using serial isotopic glomerular filtration rate and 99 m technetium-mercaptoacetyltriglycine renography. J Urol 176:2518–2522
Eisenberg MS, Thompson RH, Frank I et al (2013) Long-term renal function outcomes after radical cystectomy. J Urol. doi:10.1016/j.juro.2013.09.011 (in press)
Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612
Hirokawa M, Iwasaki A, Yamazaki A et al (1989) Improved technique of tubeless cutaneous ureterostomy and results of permanent urinary diversion. Eur Urol 16:125–132
Kouba E, Sands M, Lentz A et al (2007) A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer. J Urol 178:945–948
Miyake H, Furukawa J, Sakai I et al (2013) Orthotopic sigmoid vs. ileal neobladders in Japanese patients: a comparative assessment of complications, functional outcomes, and quality of life. Urol Oncol 31:1155–1160
Matsuo S, Imai E, Horio M et al (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992
Stein JP, Lieskovsky G, Cote R et al (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19:666–675
Hautmann RE, Abol-Enein H, Davidsson T et al (2013) ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol 63:67–80
Kim CJ, Wakabayashi Y, Sakano Y et al (2005) Simple technique for improving tubeless cutaneous ureterostomy. Urology 65:1221–1225
Hautmann RE (2003) Urinary diversion: ileal conduit to neobladder. J Urol 169:834–842
Harraz AM, Mosbah A, Abdel-Latif M et al (2013) Impact of the type of ureteroileal anastomosis on the renal function measured by diuretic scintigraphy: the long-term results of a prospective randomized study. BJU Int. doi:10.1111/bju.12511 (in press)
Bakris GL, Williams M, Dworkin L et al (2000) Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 36:646–661
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Nishikawa, M., Miyake, H., Yamashita, M. et al. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol 19, 1105–1111 (2014). https://doi.org/10.1007/s10147-014-0661-y
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DOI: https://doi.org/10.1007/s10147-014-0661-y