Preoperative hydronephrosis: independent predictor for changes in renal function following nephroureterectomy

Area of Science:

• Urology
• Oncology
• Nephrology

Background:

• Upper tract urothelial carcinoma (UTUC) can cause urinary obstruction, impacting renal function.
• Tumor-induced obstruction may affect eligibility for perioperative cisplatin-based chemotherapy.
• Preoperative hydronephrosis is a potential indicator of renal compromise in UTUC patients.

Purpose of the Study:

• To evaluate if preoperative hydronephrosis status offers additional predictive value for perioperative renal function changes.
• To determine the association between hydronephrosis grade and renal function in UTUC patients undergoing nephroureterectomy.
• To identify predictors of ineligibility for cisplatin-based chemotherapy in UTUC.

Main Methods:

• Retrospective analysis of 155 UTUC patients who underwent nephroureterectomy (1997-2010).
• Assessment of preoperative parameters, including hydronephrosis grade, and their correlation with perioperative renal function.
• Multivariate analysis to identify independent risk factors for chemotherapy ineligibility.

Main Results:

• Hydronephrosis was present in 104 patients (67.1%), with varying grades.
• Only 60.6% of patients were eligible for neoadjuvant cisplatin chemotherapy (creatinine clearance ≥50 ml/min).
• Advanced age (≥70 years) and absence of higher-grade hydronephrosis were independent predictors of ineligibility for adjuvant cisplatin chemotherapy.

Conclusions:

• Preoperative hydronephrosis status is a significant independent predictor of eligibility for adjuvant cisplatin-based chemotherapy.
• Combining hydronephrosis status with patient age can aid in decision-making for neoadjuvant cisplatin chemotherapy.
• These findings highlight the importance of assessing hydronephrosis in UTUC patients for chemotherapy planning.