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Renal function change after refluxing type orthotopic ileal substitution
Cheryn Song1, Seong Cheol Kim, Jinsung Park
1Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
The Journal of Urology
|September 28, 2011
Summary
Vesicoureteral reflux in urinary diversion does not impact kidney function unless post-void residual urine is present. Post-void residual urine is a key risk factor for infection and kidney function decline.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Radical cystectomy often necessitates urinary diversion.
- Ileal orthotopic bladder substitutes and ileal conduits are common diversion types.
- The impact of vesicoureteral reflux on renal function in these diversions requires clarification.
Purpose of the Study:
- To investigate the effect of vesicoureteral reflux (VUR) presence and severity on renal function in patients with ileal orthotopic bladder substitutes.
- To compare these findings with patients who received an ileal conduit diversion.
Main Methods:
- Evaluated 101 patients (195 renal units) post-radical cystectomy.
- Measured individual glomerular filtration rates (GFR) using (99m)technetium diethylenetetramine pentaacetic acid renal scans.
- Analyzed GFR changes in relation to VUR presence, severity, and post-void residual urine.
Main Results:
- Vesicoureteral reflux occurred in 73.2% of renal units with orthotopic substitutes.
- No significant change in mean GFR was observed perioperatively.
- Neither VUR presence nor severity impacted GFR; however, post-void residual urine predicted GFR decrease (p = 0.009).
Conclusions:
- Vesicoureteral reflux in urinary diversions does not significantly affect renal function.
- Post-void residual urine is a critical risk factor for febrile urinary tract infection and renal function deterioration.
- Management strategies should address post-void residual urine to preserve renal function.
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