278 Presence of transient hydronephrosis at 1 month after surgery has no significant impact on renal function at 1 year after ileal neobladder construction

Abstract

INTRODUCTION AND OBJECTIVES: Risk of renal insufficiency has historically been viewed as a long-term consequence of urinary diversion after radical cystectomy. There is, however, little data comparing long-term rates of end-stage kidney disease (ESKD) in patients who have had a cystectomy in the setting of bladder cancer. We evaluated the risk of end stage kidney disease (ESKD) in patients who received ileal conduit versus continent urinary diversion after cystectomy for bladder cancer using a large population cohort. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset, we identified 4,511 patients who underwent radical cystectomy for bladder cancer, excluding those with pre-existing renal disease. The outcome of interest was the development of ESKD, stratified according to diversion type (continent vs. conduit diversion) while controlling for multiple factors including Charlson comorbidity score, age, and grade/stage of tumor in multivariate logistic regression models. Median follow up was 41 months (interquartile range1⁄419-78 months). RESULTS: Two hundred fifty patients (5.4%) developed ESKD. 83% of the patients received ileal conduit, and 17% received continent urinary diversion. On multivariate analysis, when controlling for known confounders, there was no increased risk of developing ESKD associated with a continent diversion (HR 0.85, 95% CI 0.60-1.19). Charlson co-morbidity score 1 predicted risk of developing ESKD compared with patients of Charlson score of 0 at time of cystectomy (HR 1.55, 95% CI 1.19-2.02, p 0.001). 5-year and 10-year cancer-specific and overall survival were higher in those who received continent urinary diversion (p<0.0001). CONCLUSIONS: Continent urinary diversion does not portend increased risk of ESKD compared to ileal conduit. This data suggests that co-morbidities at time of cystectomy, rather than age or type of diversion, increased the risk of ESKD in patients undergoing cystectomy. Continent urinary diversion was also associated with improved overall survival compared with those receiving ileal conduit, likely secondary to selection bias not completely controlled for with Charlson comorbidity Index and age.