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The effect of urinary diversion on long-term kidney function after cystectomy
Kassem S Faraj1, Lanyu Mi2, Sarah Eversman3
1Department of Urology (Drs Faraj, Swanson, Andrews, Ferrigni, Humphreys, Castle, and Tyson), Mayo Clinic Hospital, Phoenix, Arizona.
Urologic Oncology
|June 3, 2020
Summary
This study compared kidney function after cystectomy with urinary diversion, finding no significant difference between ileal conduit (IC) and neobladder (NB) in long-term kidney function. However, some analyses suggested a potential trend of greater kidney function decline with IC.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Cystectomy with urinary diversion can impact long-term kidney function.
- The choice between ileal conduit (IC) and neobladder (NB) for urinary diversion is debated regarding its effect on renal function.
Purpose of the Study:
- To test the hypothesis that long-term kidney function does not vary by urinary diversion type after cystectomy.
- To compare glomerular filtration rate (GFR) changes over time between IC and NB cohorts.
Main Methods:
- Retrospective analysis of 563 patients undergoing cystectomy with urinary diversion (2007-2018).
- GFR calculated using CKD-EPI equation, analyzed with inverse probability of treatment weighting (IPTW) linear mixed model.
- Sensitivity analyses performed using MDRD equation and excluding patients with low baseline GFR.
Main Results:
- Both NB and IC groups showed decreased kidney function over time (5-year GFR loss: 17% NB, 14% IC).
- IPTW-adjusted analysis showed a non-significant trend towards greater GFR deterioration in the IC cohort (P=0.06).
- Sensitivity analysis using MDRD equation showed a statistically significant trend of greater GFR decline in the IC cohort (P=0.04).
Conclusions:
- Highly selected neobladder patients may experience less kidney function deterioration than ileal conduit patients.
- Observed differences were cautiously attributed to patient selection, as statistical significance varied across analyses.
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