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 Ileocecal Pouch.

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

Urologia Internationalis Pub Date : 2024-07-31 DOI:10.1159/000540096

Marcel Schwinger, Anna Katharina Seitz, Hubert Kübler, Arkadius Kocot, Hubertus Riedmiller, Charis Kalogirou

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引用次数: 0

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 preoperative renal function, a comorbidity index (Age-Adjusted Charlson 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 versus non-refluxing ureteric implantation (estimated glomerular filtration rate: 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 chronic kidney disease (CKD) (both 15%, p = 1), the need for alkalizing medication, or the 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 counseled according to their comorbidities regarding long-term renal function.

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大陆性皮下尿路改道中的反流与非反流输尿管植入术：关于回肠盲肠袋患者长期肾脏、代谢和功能结果的倾向评分比较。

导言：在大陆性皮下尿路转流术（CCUD）中，比较反流式与非反流式输尿管植入术的研究很少，而且研究对象往往不尽相同。因此，这项研究旨在通过倾向评分法比较两种技术的长期疗效。方法我们从120名患者中筛选出19名患者，共38个肾单位（RU），在本医院接受了CCUD手术。在这 38 个肾单位中，有 27 个肾单位是由于术中的特殊情况（输尿管过短、辐射损伤）而采用不同的程序通过反流输尿管植入术植入的。就术前肾功能、合并症指数（ACCI）和性别而言，我们将这些患者与在所有 RU 中进行非反流输尿管植入术的 n = 38 例共 76 例 RU 患者进行了比较（1:2 匹配）。平均随访时间为 56 个月（IQR 23-112 个月）。结果接受反流与非反流输尿管植入术的 CCUD 患者的长期肾功能相当（eGFR 分别为 63.11 毫升/分钟和 71.7 毫升/分钟，P=0.22），随访期间平均下降幅度分别为 17.4 毫升/分钟和 13.69 毫升/分钟。此外，新发慢性肾功能衰竭率（均为 15%，P=1）、碱化药物需求或肾盂肾炎发作次数在两组之间也没有显著差异。在 cox 回归分析中，ACCI 是最能预测新发 CKD 的单一参数（HR：1.71 [1.10-2.66]，P=0.0167）。反流组中没有一名 RU 需要进行输尿管肠吻合术的翻修手术，而非反流组中有 7 名 RU 需要这样做。结论我们的研究证实，就长期肾脏、代谢和功能结果而言，在 CCUD 中植入反流输尿管是一种有效而安全的手术。我们的数据还表明，应根据患者的合并症对其长期肾功能进行指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologia Internationalis 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.