Abstract
Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.
Highlights
Radical cystectomy is widely used as the most effective treatment for muscle-invasive bladder cancer [1]
Two hundred and eighty-seven patients were excluded (199 patients owing to incomplete medical records, 80 owing to combined surgery with radical cystectomy, and 8 owing to known end-stage renal disease (ESRD))
The present study showed that 12.8% of the patients developed a significant decline in the glomerular filtration rate (GFR) 12 months after radical cystectomy with urinary diversion
Summary
Radical cystectomy is widely used as the most effective treatment for muscle-invasive bladder cancer [1]. The two most frequently used methods for urinary diversion in radical cystectomy are ileal conduit urinary diversion and ileal neobladder urinary diversion. There is an ongoing debate regarding the selection of the appropriate urinary diversion type in radical cystectomy [2]. The ileal neobladder urinary diversion maintains anatomical voiding and can increase the quality of life of patients [4]. Complications such as ureteroileal stricture, bladder outlet obstruction, and hydronephrosis can occur after ileal neobladder urinary diversion [5,6,7]. The type of urinary diversion in radical cystectomy should be carefully selected considering patient characteristics and postoperative complications
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