Refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion: a propensity-scored comparison regarding long-term renal, metabolic and functional outcomes of patients with ileocoecal pouch.

Abstract

Introduction Studies comparing refluxing versus non-refluxing ureteric implantation in continent cutaneous urinary diversion (CCUD) are scarce and often characterized by heterogeneous study populations. This work therefore aimed at comparing both techniques regarding long-term outcomes in a propensity-scored approach. Methods We identified n = 19 patients, totaling n = 38 renal units (RU), who underwent CCUD surgery at our hospital out of a pool of 120 patients. Of these 38 RU, 27 RU were implanted via refluxing ureteric implantation utilizing various procedures due to special intraoperative circumstances (short ureters, damage due to radiation). In terms of pre-operative renal function, a comorbidity index (ACCI), and gender, we compared them to n = 38 patients with a total of 76 RU with non-refluxing ureteric implantation in all RU (1:2 matching). The mean follow-up was 56 (IQR 23-112) months. Results Long-term renal function was comparable in CCUD patients receiving refluxing vs. non-refluxing ureteric implantation (eGFR 63,11 ml/min vs. 71,7 ml/min, p=0,22) with an average decline of 17,4 ml/min and 13,69 ml/min during the follow-up period, respectively. Also, the rate of new-onset CKD (both 15%, p=1), the need for alkalizing medication or number of pyelonephritis episodes did not significantly differ between the groups. In cox regression analysis, ACCI was the single most predictive parameter for the development of new-onset CKD (HR: 1.71 [1.10-2.66], p=0.0167). None of the RU in the refluxing group needed revisional surgery concerning the ureterointestinal anastomosis, whereas 7 RU of the non-refluxing group did. Conclusions Our study confirms that refluxing ureteric implantation in CCUDs is a valid and safe procedure regarding long-term renal, metabolic and functional outcomes. Our data also suggest that patients should be counselled according to their comorbidities regarding to long-term renal function.