Kidney function improvement after urinary diversion for cisplatin eligibility in bladder cancer patients.

Abstract

Background: Muscle-invasive bladder cancer (MIBC) is an aggressive disease typically treated with radical cystectomy following neoadjuvant chemotherapy (NAC). However, the presence of hydronephrosis - a significant marker of advanced disease - can impair renal function, potentially precluding patients from receiving cisplatin-based NAC.

Objective: The present study aimed to assess the role of urinary diversion in patients with MIBC, specifically in reversing renal function impairment and enabling eligibility for cisplatin-based therapy.

Methods: A retrospective study was performed by evaluating a database of patients treated for urothelial MIBC from 2018 to 2021. Case notes were reviewed to identify patients with hydronephrosis who underwent urinary diversion. The types of urinary diversion recorded included percutaneous nephrostomy, ureteral stenting, or surgical obstruction release. Renal function was assessed retrospectively using the glomerular filtration rate (GFR), estimated from creatinine clearance.

Results: Records of a total of 72 patients were evaluated. The mean GFR before urinary diversion was 44.1 ± 26.4 mL/min, which improved to 59.1 ± 31.9 mL/min post-diversion, resulting in a mean GFR improvement of 15.0 ± 20.0 mL/min. Forty-four patients had an initial GFR below 50 mL/min, with 75% of them achieving a GFR >50 mL/min after urinary diversion. More than half of these patients (n = 25, 56%) experienced an improvement to a GFR exceeding 60 mL/min. The time to reach the best GFR varied widely (mean: 59 ± 33 days, range 9 - 165 days). Logistic regression analysis identified initial GFR as a significant predictor of GFR recovery (odds ratio = 1.11, 95% confidence interval = 1.02 - 1.21, p = 0.012).

Conclusion: Urinary diversion can benefit patients with upper tract obstruction secondary to MIBC by improving renal function, thereby enabling eligibility for cisplatin-based chemotherapy. Notably, the time to GFR recovery following urinary diversion varied among individuals.