TY - JOUR
T1 - Neobladder creation in patients with chronic kidney disease
T2 - A viable diversion strategy
AU - Ranti, Daniel
AU - Pfail, John
AU - Garcia, Mariely
AU - Razdan, Shirin
AU - Bieber, Christine
AU - Rosenzweig, Shoshana
AU - Waingankar, Nikhil
AU - Hosseini, Abolfazl
AU - Radros, Jari
AU - Mehrazin, Reza
AU - Lavallée, Etienne
AU - Wiklund, Peter N.
AU - Sfakianos, John P.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/4
Y1 - 2022/4
N2 - Introduction: Renal function impairment is often cited as a contraindication to continent diversion strategies. There is little evidence exploring renal function changes between continent and incontinent surgery in patients with preoperative chronic kidney disease (CKD), in particular CKD3B. Methods: This was a retrospective review of two high-volume centers performing robotic assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) or ileal conduit (IC) between 2014 to 2020. Patients were stratified based on CKD estimated glomerular filtration (eGFR) stage, which was estimated via the CKD-EPI equation. Postoperative renal function was compared for up to 60 months postoperative. Surgical, post-surgical, complications, and readmission data were gathered and compared between all patients Results: 522 cystectomy patients, 430 with IC and 125 with ONB, were included. eGFR decline was statistically significant in a matched cohort of IC and ONB patients only at 3 months. There were no statistically significant differences between readmission rates, time to readmission, or complications. 34.6% of stage 3B patients had hydronephrosis on imaging prior to surgery, compared to 11.4%, 22.1% and 21.8% of CKD stage 1, 2, and 3A patients. CKD stage 3B had statistically and clinically improved eGFR through 24 months. Conclusion: ONB surgery may be a viable diversion strategy in patients previously thought to be contraindicated due to low renal function.
AB - Introduction: Renal function impairment is often cited as a contraindication to continent diversion strategies. There is little evidence exploring renal function changes between continent and incontinent surgery in patients with preoperative chronic kidney disease (CKD), in particular CKD3B. Methods: This was a retrospective review of two high-volume centers performing robotic assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) or ileal conduit (IC) between 2014 to 2020. Patients were stratified based on CKD estimated glomerular filtration (eGFR) stage, which was estimated via the CKD-EPI equation. Postoperative renal function was compared for up to 60 months postoperative. Surgical, post-surgical, complications, and readmission data were gathered and compared between all patients Results: 522 cystectomy patients, 430 with IC and 125 with ONB, were included. eGFR decline was statistically significant in a matched cohort of IC and ONB patients only at 3 months. There were no statistically significant differences between readmission rates, time to readmission, or complications. 34.6% of stage 3B patients had hydronephrosis on imaging prior to surgery, compared to 11.4%, 22.1% and 21.8% of CKD stage 1, 2, and 3A patients. CKD stage 3B had statistically and clinically improved eGFR through 24 months. Conclusion: ONB surgery may be a viable diversion strategy in patients previously thought to be contraindicated due to low renal function.
KW - Orthotopic neobladder
KW - Patient selection
KW - Presurgical optimization
KW - Robotic-assisted radical cystectomy
KW - Urinary diversion
UR - http://www.scopus.com/inward/record.url?scp=85122959162&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2021.11.023
DO - 10.1016/j.urolonc.2021.11.023
M3 - Article
C2 - 35039217
AN - SCOPUS:85122959162
SN - 1078-1439
VL - 40
SP - 168.e21-168.e27
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 4
ER -