PD51-08 RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER IN WOMEN

Abstract

INTRODUCTION AND OBJECTIVE: Available data regarding long-term survival and functional outcomes after surgery are limited. Herein, we report on the long-term survival and functional outcome, 10 years or more after RC. METHODS: We retrieved all electronic data of the prospectively evaluated women who underwent RC and ONB in our institute between 1995 and 2009. Patients’ demographics including early and late complications were retrieved. Cancer-specific survival and overall survival were assessed. Patients completed ≥10 years of follow-up were evaluated for continence, voiding status and renal function. Renal function was estimated using serum creatinine (Sr.Cr) and eGFR (measured by Modification of Diet in Kidney Disease Equation) and compared to preoperative values using Wilcoxon matched-pair signed-rank test. Significant renal function changes (improvement or deterioration) were considered when > 20% changes in eGFR occurred in comparison to preoperative value. Univariate and multivariate analysis were performed to determine predictors of renal function deterioration. RESULTS: The study included 297 patients with mean± SD age of 51.3±9.1 years. Patients’ demographic criteria were illustrated in table 1. At a median (range) follow up of 78 (0-247) months, CSS and OS were 78.1% and 62%, respectively (Figure 1). Among 184 disease-free living patients, 95 were lost follow-up after 67.5 (12-109) months of follow up. Eighty nine completed more than 10 years (164.5±34.7 months) of follow up. At last follow-up, 80 patients (90%) were totally continent at daytime; 3 of them achieved continence after treatment of chronic urinary retention (CUR) by clean intermittent catheterization (CIC). The remaining 9 patients had total (3) or varying degrees of stress (6) urinary incontinence. Night time continence was achieved in 56 patients (63%); 8 of them were having CUR and cured by CIC and anticholinergics. CUR was noted in 29 (32.6%) patients. Compared to preoperative values, there were statistically significant increase in serum creatinine [0.8 (0.5-1.5) to 1 (0.5-5.3), P<0.001] and decrease in eGFR [84.4 (46-134) to 65.3 (11-125), P< 0.001]. Six (6.7%) and three (3.4%) patients developed grade IV and grade V CKD, respectively. Forty six (51.7%) and 43 (48.3%) patients showed significant decline and static renal function, respectively. In univariate analysis, young patients’ age, higher serum Cr, lower eGFR and DM were the predictors of renal function decline (P<0.05). In multivariate analysis, only DM was the independent predictor of renal function decline [OR (95%CI)= 12.7 (1.15-41.38), p=0.03]. CONCLUSIONS: Ten years after RC and ONB in women, 30% are disease-free and have acceptable continence status. Although a decline in kidney function is noted in 50% of the cases, only 10% develop ESRD. Diabetes mellitus has been proved to be an independent predictor of renal function decline.IDyGZAAAAAElFTkSuQmCC"> Source of Funding: no funding