Abstract
Deterioration of renal function has been reported after radical cystectomy (RC) with urinary diversion. We investigated renal function changes in elderly bladder cancer (BCa) patients who underwent RC with cutaneous ureterostomy (CU) urinary diversion. We performed a retrospective, observational study. BCa patients aged ≥75 with an American Society of Anesthesiologists (ASA) class greater than II were included. Glomerular filtration rate (GFR) was the main outcome measure. GFR values were recorded preoperatively, at discharge, at 6-month follow-up, and yearly up to 60 months. A total of 70 patients with a median age of 78.0 years were identified. Median preoperative GFR was 74.3 mL/min/1.73 m2 and declined significantly to 54.6 mL/min/1.73 m2 after 6 months (p < 0.001). A gradual GFR decline was observed thereafter, reaching a median value of 46.2 after 60 months. Preoperative GFR and acute kidney injury were significant predictors of fast deterioration of GFR and of 25% deterioration of GFR after 12 months. Elderly BCa patients with high comorbidity rates undergoing RC with CU should be carefully informed about the risk of GFR deterioration and the need for adequate monitoring.
Highlights
Radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion represents the standard of care for patients with muscle-invasive bladder cancer (BCa) and for selected patients with high-risk, nonmuscle-invasive disease [1,2,3].This surgical procedure has been reported to be associated with deterioration of renal function with subsequent increased risk of perioperative and long-term morbidity and mortality due to the established association between chronic kidney disease (CKD) and cardiovascular morbidity and mortality [3,4,5,6,7]
Inclusion criteria were BCa patients with a history of RC with cutaneous ureterostomy (CU) urinary diversion performed at a single institution, age ≥75 years, and American Society of Anesthesiologists (ASA) class greater than II
Scoring the level of renal function based only on CKD stage is affected by the width range of Glomerular filtration rate (GFR), primarily in the II–III CKD stages, where a decrease in GFR of more than 10 mL/min is considered stable but would be considered worsened if the patient were in CKD stage IV [10]
Summary
Radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion represents the standard of care for patients with muscle-invasive bladder cancer (BCa) and for selected patients with high-risk, nonmuscle-invasive disease [1,2,3]. This surgical procedure has been reported to be associated with deterioration of renal function with subsequent increased risk of perioperative and long-term morbidity and mortality due to the established association between chronic kidney disease (CKD) and cardiovascular morbidity and mortality [3,4,5,6,7]. Data on acute and year-by-year changes in renal function after RC with urinary diversion are very scarce
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