Long-term renal function in patients undergoing surgical reconstruction for tubercular cicatrized bladder

Area of Science:

• Urology
• Nephrology
• Surgical Reconstruction

Background:

• Tuberculous contracted bladder (TBC) often requires surgical intervention, such as augmentation cystoplasty (AC) or orthotopic neobladder (ONB).
• Long-term outcomes, particularly renal function, after these complex reconstructive procedures for TBC are not fully understood.

Purpose of the Study:

• To evaluate long-term renal function in patients following surgical reconstruction for TBC.
• To identify factors associated with decreased renal function (RF) during the follow-up period.

Main Methods:

• Retrospective review of 61 patients who underwent AC or ONB for TBC between 1994 and 2019.
• Calculation of estimated glomerular filtration rate (eGFR) at presentation, pre-augmentation, and during follow-up.
• Definition of RF decrease as new-onset stage-3A Chronic Kidney Disease (CKD) or upstaging of pre-existing CKD 3A; multivariable analysis performed.

Main Results:

• Analysis included 39 patients with at least 1-year follow-up; 16/39 experienced RF decrease at a median of 52 months.
• Univariate analysis showed initial eGFR and contralateral ureteric stricture were significant predictors.
• Multivariable analysis identified initial presenting eGFR as the sole independent predictor (p < 0.001), with an ROC cut-off of 45 ml/min.

Conclusions:

• Decreased renal function is a common long-term complication after TBC reconstruction.
• Patients presenting with an initial eGFR < 45 ml/min are at significantly higher risk for subsequent renal function decline post-reconstruction.