Abstract
ObjectivesTo assess the effects of urinary diversion on renal function, we retrospectively investigated renal function over 5 years after urinary diversion using a propensity score matching strategy.MethodsBetween May 1996 and November 2013, 345 consecutive adult patients underwent radical cystectomy and urinary diversion in our hospital; one hundred and fifteen patients with more than a 5-year follow-up were enrolled. Propensity scores were calculated using logistic analysis, and the data used in the analyses included age, gender, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), clinical tumor stage, presence of cardiovascular disease; hypertension; and type 2 diabetes and preoperative eGFR at the initial visit. Multivariate logistic regression analysis was used to assess the risk factors for stage 3B chronic kidney disease (CKD) after the different types of urinary diversion.ResultsContinent and incontinent diversion were performed in 68 and 47 patients, respectively. The mean preoperative eGFR was significantly lower in the incontinent than in the continent group (P < 0.001). In propensity score-matched patients (n = 34 each), no significant differences were observed in pre- and postoperative eGFR and 5-year eGFR decrease rates between the groups. In the incontinent group, the number of postoperative stage 3B CKD patients was significantly increased than the continent group. Using multivariate analysis, independent risk factors significantly associated with stage 3B CKD at 5 years after surgery were older age, eGFR before surgery, incontinent diversion (cutaneous ureterostomy), and postoperative hydronephrosis.ConclusionsThe types of urinary diversion had no significant impact on renal function decline, whereas older age, preexisting impaired renal function, postoperative hydronephrosis, and cutaneous ureterostomy were independent risk factors for stage 3B CKD at 5 years after radical cystectomy.
Highlights
Radical cystectomy and urinary diversion remain the standard treatment modality for muscleinvasive bladder cancer patients
Independent risk factors significantly associated with stage 3B chronic kidney disease (CKD) at 5 years after surgery
The types of urinary diversion had no significant impact on renal function decline, whereas older age, preexisting impaired renal function, postoperative hydronephrosis, and cutaneous ureterostomy were independent risk factors for stage 3B CKD at 5 years after radical cystectomy
Summary
Radical cystectomy and urinary diversion remain the standard treatment modality for muscleinvasive bladder cancer patients These are associated with the significant risks of perioperative and long-term morbidity and mortality,[1, 2] including subsequent renal function decline.[3, 4] The goals of urinary diversion after radical cystectomy have evolved from the protection of the upper tracts to functional and anatomical restoration because of the high proportion of bladder cancer patients presenting with impaired renal function.[5] Patients with urinary diversion are notably at a high risk of renal function decline,[6] and with chronic kidney disease (CKD) have a high risk for cardiovascular disease and all-cause mortality.[7] limited evidence describing the effects of urinary diversion on renal function after radical cystectomy is available, and results are controversial.[8,9,10,11,12,13,14] Recent studies supported choice of urinary diversion was not independently associated with renal function decline. Their findings need to be confirmed in Japanese people
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