Biphasic change in renal function after radical cystectomy and urinary diversion: Result from tertiary center in Thailand

Abstract

Purpose: Radical cystectomy (RC) with urinary diversion has been established as the gold standard treatment for muscle invasive bladder cancer. This provides excellent local control and increases the survival rate. The postoperative renal function (RF) usually declines, especially with those with risky conditions such as increasing age, hypertension, diabetes, or the presence of preoperative hydronephrosis (HN). However, there are limited data about the potential preoperative factors to predict the postoperative RF following the RC. The current retrospective article aims at reviewing patients treated with RC with urinary diversion presenting demographics data, assessing the RF after performing the operation and identifying the associated factors that reduce the RF. Materials and Methods: Bladder cancer patients who underwent RC with a urinary diversion from January 2001 to December 2017 were reviewed. RF was assessed by using the estimated glomerular filtration rate (eGFR) through the MDRD formula. Multivariate analysis was performed to evaluate the association of the changing of RF. Results: One hundred and fifty-six patients were included in the study. The median age was 65 years (interquartile ranges [IQR] 57, 72), and the median follow-up time was 16.4 months (IQR 7.1, 33.4). Overall, 86 patients (55.12%) had HN at the initial treatment of RC. Baseline mean eGFR was 57.7 mL/min/1.73 m2 (standard deviation [SD] = 23.7). The value of eGFR observed at 1, 12, and 60 months was 67.2 (SD = 29.5), 55.7 (SD = 26.3), and 55.8 (SD = 21.4) mL/min/1.73 m2, respectively. At 1 month, female gender, no HN, and neobladder were independently associated with worse RF outcomes in both univariate and multivariate analysis (P < 0.05). The factors associated with eGFR under 60 mL/min/1.73 m2 at 1 year were age, presence of HN, and adjuvant treatment. Conclusion: RF after cystectomy and urinary diversion improves for 1 month after the procedure, especially in patients with the presence of preoperative HN and then RF gradually decreases. There are no significant differences in preoperative and postoperative RF after a 5-year follow-up.