Introduction: Despite good supporting evidence, the dogma still exists that patients with renal insufficiency are not good candidates for continent diversions. In this paper, we attempt to evaluate this relationship and investigate the short-term effects of continent and noncontinent diversions on patients with both normal renal function and preexisting renal insufficiency.
Methods: From Sept 2004 to June 2009, 212 adult patients underwent radical cystectomy and intestinal urinary diversion by a single surgeon (SD). Forty-four were excluded secondary to inadequate follow-up (41) or other factors leading to renal compromise (3). Continent diversions were performed either with a Studer orthotopic ileal neobladder (ONB) or a catheterizable stoma with right colon pouch. Evaluation of renal function included pre- and postoperative serum creatinine, bicarbonate, and estimated glomerular filtration rate (eGFR) using the National Kidney Foundation (MDRD) equation. A multivariable linear regression model was used to assess the influence of different urinary diversions on the change in renal function.
Results: Median follow-up for the 168 patients was 18.7 months (3 to 60 months). Forty-four patients underwent ileal conduit and 124 underwent continent diversion (109 ONBs; 15 continent cutaneous diversions). The mean preoperative eGFR between the conduit and continent groups was 63.8 and 73.3, respectively (P < 0.001). The mean decrease in eGFR between the 2 groups was -4.1 and -10.3, respectively (P = 0.41). In patients with preexisting renal insufficiency, the mean change in eGFR was 1.7 and -0.49, respectively (P = 0.49).
Conclusions: The mean change in eGFR, creatinine, and bicarbonate levels following urinary diversion with either conduit or continent diversions were not statistically different in patients with normal or preexisting renal insufficiency at short-term follow-up. This data suggests that mild preexisting renal insufficiency may not be a contraindication to continent diversion.
Brian Winters, Jie Cai, Siamak Daneshmand
Submitted January 21, 2013 - Accepted for Publication February 19, 2013
KEYWORDS: Ileal conduit, orthotopic neobladder, renal function, urinary diversion
CORRESPONDENCE: Siamak Daneshmand, MD, Institute of Urology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, United States ()
CITATION: UroToday Int J. 2013 April;6(2):art 20. http://dx.doi.org/10.3834/uij.1944-5784.2013.04.07