Long-Term Renal Function Outcomes after Radical Cystectomy

No AccessJournal of UrologyAdult Urology1 Mar 2014Long-Term Renal Function Outcomes after Radical Cystectomy Manuel S. Eisenberg, R. Houston Thompson, Igor Frank, Simon P. Kim, Katherine J. Cotter, Matthew K. Tollefson, Dharam Kaushik, Prabin Thapa, Robert Tarrell, and Stephen A. Boorjian Manuel S. EisenbergManuel S. Eisenberg Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Igor FrankIgor Frank Department of Urology, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Rochester Medical. More articles by this author , Simon P. KimSimon P. Kim Department of Urology, Yale University, New Haven, Connecticut More articles by this author , Katherine J. CotterKatherine J. Cotter Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author , Matthew K. TollefsonMatthew K. Tollefson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Dharam KaushikDharam Kaushik Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Prabin ThapaPrabin Thapa Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author , Robert TarrellRobert Tarrell Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author , and Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.09.011AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the long-term natural history of renal function after radical cystectomy with urinary diversion and determined factors associated with decreased renal function. Materials and Methods: We reviewed the records of 1,631 patients who underwent radical cystectomy between 1980 and 2006. The estimated glomerular filtration rate was calculated preoperatively and at various intervals after surgery. A renal function decrease was defined as a greater than 10 ml per minute/1.73 m2 reduction in the estimated glomerular filtration rate. Multivariate analysis was done to evaluate the association of clinicopathological features, incontinent vs continent diversion type and postoperative complications with decreased renal function. Results: A total of 1,241 patients (76%) underwent incontinent diversion and 390 (24%) underwent continent diversion. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.1, 15.3). The median preoperative estimated glomerular filtration rate was higher in the continent diversion cohort (67 vs 59 ml per minute/1.73 m2, p <0.0001). This difference was maintained until 7 years postoperatively, after which no difference was noted in renal function by diversion type. By 10 years after radical cystectomy the risk of a renal function decrease was similar for incontinent and continent diversion (71% and 74%, respectively, p = 0.13). On multivariate analysis risk factors associated with decreased renal function included age (HR 1.03, p <0.0001), preoperative estimated glomerular filtration rate (HR 1.05, p <0.0001), chronic hypertension (HR 1.2, p = 0.01), postoperative hydronephrosis (HR 1.2, p = 0.03), pyelonephritis (HR 1.3, p = 0.01) and ureteroenteric stricture (HR 1.6, p <0.0001). Conclusions: Decreased renal function is noted in most patients during long-term followup after radical cystectomy. Postoperative hydronephrosis, pyelonephritis and ureteroenteric stricture represent potentially modifiable factors associated with a decrease. Choice of urinary diversion was not independently associated with decreased renal function. References 1 Cancer Facts & Figures 2013. Atlanta: American Cancer Society2013. Google Scholar 2 : NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Fort Washington, Pennsylvania: National Comprehensive Cancer Network®2011. Google Scholar 3 : Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol2009; 55: 164. Google Scholar 4 : Long-term complications of conduit urinary diversion. J Urol2011; 185: 562. Link, Google Scholar 5 : 25 Years of experience with 1,000 neobladders: long-term complications. J Urol2011; 185: 2207. Link, Google Scholar 6 : Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol2010; 57: 983. Google Scholar 7 : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med2004; 351: 1296. Google Scholar 8 : Long-term outcome of ileal conduit diversion. J Urol2003; 169: 985. Link, Google Scholar 9 : The natural history of postoperative renal function in patients undergoing ileal conduit diversion for cancer measured using serial isotopic glomerular filtration rate and 99mtechnetium-mercaptoacetyltriglycine renography. J Urol2006; 176: 2518. Link, Google Scholar 10 : Long-term results of standard procedures in urology: the ileal neobladder. World J Urol2006; 24: 305. Google Scholar 11 : Long-term effects of ileal conduit urinary diversion on upper urinary tract in bladder cancer. Urology2006; 68: 324. Google Scholar 12 : Renal and functional outcomes following cystectomy and neobladder reconstruction. Can Urol Assoc J2010; 4: 328. Google Scholar 13 : Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term?. J Urol2002; 168: 2030. Link, Google Scholar 14 : A new equation to estimate glomerular filtration rate. Ann Intern Med2009; 150: 604. Google Scholar 15 : Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. JAMA2012; 307: 1941. Google Scholar 16 : Pro: estimating GFR using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 creatinine equation: the time for change is now. Nephrol Dial Transplant2013; 28: 1390. Google Scholar 17 : Performance of the chronic kidney disease-epidemiology study equations for estimating glomerular filtration rate before and after nephrectomy. J Urol2010; 183: 896. Link, Google Scholar 18 : Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol2012; 61: 491. Google Scholar 19 : Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long term oncological, functional and quality of life results. Int Braz J Urol2010; 36: 537. Google Scholar 20 : Accurate determination of renal function in patients with intestinal urinary diversions. J Urol1986; 135: 1175. Link, Google Scholar 21 : A study of reflux in patients with an ileal orthotopic bladder. Br J Urol1998; 81: 241. Google Scholar 22 : The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol2000; 164: 288. Link, Google Scholar 23 : Experiences with the entero-ureteral anastomosis via the extramural serous-lined tunnel: procedure of Abol-Enein. Urology2001; 57: 234. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGargollo P, Ahmed M, Prieto M, Butaney M, Cramer C, Joshi V, Heimbach J and Granberg C (2021) Feasibility Study of Vascularized Composite Urinary Bladder Allograft Transplantation in a Cadaver ModelJournal of Urology, VOL. 206, NO. 1, (115-123), Online publication date: 1-Jul-2021.Li Q, Assel M, Benfante N, Pietzak E, Bagrodia A, Cha E, Dalbagni G and Coleman J (2017) Clinical Outcomes in Patients with Panurothelial Carcinoma Treated with Radical Nephroureterectomy Following Cystectomy for Metachronous RecurrenceJournal of Urology, VOL. 198, NO. 3, (546-551), Online publication date: 1-Sep-2017.Zabell J, Adejoro O, Konety B and Weight C (2014) Risk of End Stage Kidney Disease after Radical Cystectomy According to Urinary Diversion TypeJournal of Urology, VOL. 193, NO. 4, (1283-1287), Online publication date: 1-Apr-2015.Skinner E, Fairey A, Groshen S, Daneshmand S, Cai J, Miranda G and Skinner D (2015) Randomized Trial of Studer Pouch versus T-Pouch Orthotopic Ileal Neobladder in Patients with Bladder CancerJournal of Urology, VOL. 194, NO. 2, (433-440), Online publication date: 1-Aug-2015. Volume 191Issue 3March 2014Page: 619-625 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordsurinary bladder neoplasmsrenal insufficiencycystectomyurinary diversionchronicpostoperative complicationsMetricsAuthor Information Manuel S. Eisenberg Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Igor Frank Department of Urology, Mayo Clinic, Rochester, Minnesota Financial interest and/or other relationship with Rochester Medical. More articles by this author Simon P. Kim Department of Urology, Yale University, New Haven, Connecticut More articles by this author Katherine J. Cotter Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author Matthew K. Tollefson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Dharam Kaushik Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Prabin Thapa Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author Robert Tarrell Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...