There were 235 consecutive urinary diversion surgeries reviewed from 2007 to 2018. Inclusion criteria were pre-operative urodynamics and greater than 1 year of follow-up including assessment of renal function with serum creatinine. Low bladder compliance was defined as less than or equal to 12 ml/cm H2O on urodynamics. Patients were considered to have a decline in renal function if they had a serum creatinine rise of 25% or more during follow up.
Of the 49 patients who met our inclusion criteria, the most common diagnoses were: radiation cystitis (22.4%), iatrogenic injury (18.4%), spinal cord injury (16.3%), multiple sclerosis (10.2%), and interstitial cystitis (8.2%). 55.1% of patients had abnormal bladder compliance. Those who had abnormal compliance were more likely to have a diagnosis of neurogenic bladder (p = 0.002) and vesicoureteral reflux (p =0.02). There was no other difference in baseline demographics based on compliance including age, gender, BMI, smoking status, diabetes, pre-operative radiation, or pre-operative serum creatinine. The average follow-up was four years (range 1-11 years). Mean serum creatinine before surgery was 0.84 (0.3-1.49). Mean serum creatinine at year 1 was 0.85, year 2 was 0.92, year 3 was 0.99, year 4 was 0.89, and year 5 was 0.67 (p >0.24). Seven patients (14.3%) had a 25% or greater decline in renal function during follow up. There was a trend towards patients with abnormal compliance having a higher risk of decline in renal function compared to normal compliance (22.2% versus 4.5%, p = 0.07). Additionally, patients with post-operative hydronephrosis were more likely to have a decline in renal function (85.7% versus 31%, p = 0.006). There were no other predictors of >25% change renal function including age, gender, smoking status, diabetes, pre-operative radiation, history of vesicoureteral reflux, or post-operative reoperations.
The authors concluded that renal function is generally stable after urinary diversion for benign indications, however, patients with poor bladder compliance pre-operatively and hydronephrosis on post-operative imaging are at increased risk of declining renal function over time.
Presented by: Alyssa Greiman, MD,
Co-Authors: Minsoo Choo, MD, Paholo Barboglio Romo, MD, Bahaa S. Malaeb, MD, Anne P. Cameron, MD, J. Quentin Clemens, MD, John T. Stoffel, MD, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Written by: Bilal Farhan, MD, Assistant Professor, Division of Urology, University of Texas, Medical Branch, Texas; @BilalfarhanMD, at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2020, February 25 - February 29, 2020, Scottsdale, Arizona