946 LONG-TERM OUTCOME OF RENAL FUNCTION IN BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010946 LONG-TERM OUTCOME OF RENAL FUNCTION IN BLADDER CANCER PATIENTS AFTER RADICAL CYSTECTOMY Takahiro Osawa, Satoru Maruyama, Takashige Abe, Shintaro Maru, Toshiki Aoyagi, Ataru Sazawa, Nobuo Shinohara, and Katsuya Nonomura Takahiro OsawaTakahiro Osawa More articles by this author , Satoru MaruyamaSatoru Maruyama More articles by this author , Takashige AbeTakashige Abe More articles by this author , Shintaro MaruShintaro Maru More articles by this author , Toshiki AoyagiToshiki Aoyagi More articles by this author , Ataru SazawaAtaru Sazawa More articles by this author , Nobuo ShinoharaNobuo Shinohara More articles by this author , and Katsuya NonomuraKatsuya Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1825AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There have been few publications describing the long-term outcome of renal function in bladder cancer patients who have undergone radical cystectomy (RC). In the present study, we evaluated postoperative renal function and risk factors for the loss of renal function in patients who had undergone RC. METHODS One hundred forty nine patients who had undergone RC between 1988 and 2008 were identified. After excluding the patients with resection of the entire urinary tract (n=1), preexisting renal disease (n=4), simultaneous nephrectomy or nephroureterectomy (n=22) or less than 12 months follow-up (n=52), 70 patients were included in this study [male/female=53/17, median follow up time: 47 months (range 12-243), median serum creatinine before surgery 0.8mg/dl (range 0.4-2.5)]. In this cohort, four types of urinary diversions were performed, respectively [ileal neobladder (n=24), ileocecal reservoir (n=12), ileal conduit (n=25) and cutaneous ureterostomy (n=9)]. Postoperative change of renal function was reviewed and eGFR was calculated using the standard Japanese formula (eGFR=194xAge-0.287xCr-1.094 ml/min/1.73m2 [x0.739 if female]). Renal deterioration (RD) was defined as more than 25% decrease in eGFR compared to that shown preoperatively. The variables analyzed were age (75> vs. 75<), type of urinary diversion, a prior history of hypertension (HTN) or diabetes mellitus (DM), preoperative renal function (eGFR: 60> vs. 60<), postoperative episode of acute pyelonephritis (APN), management for ureteral obstruction (yes vs. no), presence of chemotherapy (yes or no). The RD-free interval was estimated by the Kaplan-Meier method and distributions were compared by log-rank test. Cox proportional hazards model was applied for multivariate analyses. RESULTS The total eGFR was 74.6(range 15.2-155.1) ml/min/1.73m2 before surgery and 63.6(range 8.7-111.5) ml/min/1.73m2 at the last follow-up. Of these patients, 25(35.7%) developed RD at a median interval of 21.5 (range 12-228) months. Univariate analysis showed that APN (p=0.01) and presence of chemotherapy (p=0.02) were adverse factors and both of these factors remained significant on multivariate analysis (APN; HR 3.2, 95% CI 1.28-8.05, p=0.01, Presence of chemotherapy; HR 2.8, 95% CI 1.18-6.67, p= 0.02). The type of urinary diversion did not affect renal functional outcome. CONCLUSIONS Twenty-five (35.7%) patients who underwent RC demonstrated deterioration of renal function during the follow-up period. APN and presence of chemotherapy were significant adverse factors. Sapporo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e369 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takahiro Osawa More articles by this author Satoru Maruyama More articles by this author Takashige Abe More articles by this author Shintaro Maru More articles by this author Toshiki Aoyagi More articles by this author Ataru Sazawa More articles by this author Nobuo Shinohara More articles by this author Katsuya Nonomura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...