Preoperative hydronephrosis as an indicator of survival after radical cystectomy

We determined the prognostic significance of preoperative hydronephrosis in patients with transitional cell carcinoma (TCC) of the bladder undergoing radical cystectomy.

We performed a retrospective review of all patients undergoing radical cystectomy at a single institution from 1996 to 2006. Exclusion criteria included diagnosis other than TCC, upper tract TCC, incomplete medical records, or obstructing stones. Hydronephrosis was confirmed by radiographic imaging. Survival was determined by date of death or last clinic visit.

Three hundred eight patients fulfilled the inclusion criteria; 203 (66%) had normal upper tracts, 82 (27%) had unilateral hydronephrosis, and 23 (7%) had bilateral hydronephrosis. Median overall survival of the study population was 34.3 months. There was a statistically significant difference in median survival between those without hydronephrosis (46.3 months), and those with unilateral (18.6 months, P = 0.004) or bilateral (13.4 months, P < 0.001) hydronephrosis. Preoperative hydronephrosis was significantly associated with higher pT stage (P < 0.001) as well postoperative positive margins (P = 0.039), but not with positive lymph nodes (P = 0.086). Preoperative hydronephrosis had no significant effect on survival in patients with pT0-3a, N0, surgical margin negative tumors, but was significantly correlated with decreased survival in patients with pT3b or greater, or N+, or surgical margin positive tumors (median survival 12.8 months vs. 23.4 months, P = 0.011). On multivariate analysis, preoperative hydronephrosis was a significant predictor of decreased survival.

Preoperative hydronephrosis is an important and independent prognostic variable in patients with TCC of the bladder treated with radical cystectomy.