Impact of Vesico-ureteral Reflux on Renal Function after a Radical Cystectomy: a Comparison of Refluxing and Antirefluxing Orthotopic Bladder Substitutes

Abstract

Purpose: We evaluated the incidence and impact of vesico-ureteral reflux (VUR) on renal function after a radical cystectomy and the use of orthotopic bladder substitutes, using refluxing and antirefluxing type uretero-intestinal anastomosis. Materials and Methods: Sixty-five patients (124 renal units) had undergone a radical cystectomy with an ileal orthotopic substitute and received postoperative follow-up for longer than 12 months. For these patients, we evaluated the presence and grade of VUR using voiding cystourethrography (VCUG) and measured the individual glomerular filtration rate (GFR) of the corresponding renal units using a technetium diethylenetetraminepentaacetic acid (DTPA) renal scan. According to the urinary diversion (refluxing or antirefluxing methods), we analyzed the incidence of VUR and the impact of VUR on renal function. The mean follow-up time was 52 months (range 13 132 months) after surgery. Results: The incidence of VUR was higher in the refluxing anstomosis group (group R, 60.3%) of patients than in the antirefluxing group of patients (group NR, 21.7%) (p=0.001). However, the mean GFR was not significantly different (72.5ml/min/m for group R patients, 76.4ml/min/ m for group NR patients, respectively). Between the refluxing and nonrefluxing renal units, no significant difference of GFR was also noted (38.3ml/min/m versus 37.7ml/min/m). When GFR was stratified by the duration of the diversion, it was not significantly different (38.2, 36.2, and 41.7ml/min/m at 12 24, 25 48 and > 48 months, p>0.05, respectively) regardless of the diversion methods. The degree of reflux was not related to the renal function. Conclusions: Although there was a higher incidence of VUR in the refluxing type than in the antirefluxing type of orthotopic bladder substitutes, VUR developing after a radical cystectomy does not significantly alter renal function regardless of its severity or the methods and duration of the diversion. (Korean J Urol 2007;48:933-937)