Long-term renal function outcomes after radical cystectomy

Manuel S. Eisenberg, R. Houston Thompson, Igor Frank, Simon P. Kim, Katherine J. Cotter, Matthew K. Tollefson, Dharam Kaushik, Prabin Thapa, Robert Tarrell, Stephen A. Boorjian

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose We evaluated the long-term natural history of renal function after radical cystectomy with urinary diversion and determined factors associated with decreased renal function. Materials and Methods We reviewed the records of 1,631 patients who underwent radical cystectomy between 1980 and 2006. The estimated glomerular filtration rate was calculated preoperatively and at various intervals after surgery. A renal function decrease was defined as a greater than 10 ml per minute/1.73 m2 reduction in the estimated glomerular filtration rate. Multivariate analysis was done to evaluate the association of clinicopathological features, incontinent vs continent diversion type and postoperative complications with decreased renal function. Results A total of 1,241 patients (76%) underwent incontinent diversion and 390 (24%) underwent continent diversion. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.1, 15.3). The median preoperative estimated glomerular filtration rate was higher in the continent diversion cohort (67 vs 59 ml per minute/1.73 m2, p <0.0001). This difference was maintained until 7 years postoperatively, after which no difference was noted in renal function by diversion type. By 10 years after radical cystectomy the risk of a renal function decrease was similar for incontinent and continent diversion (71% and 74%, respectively, p = 0.13). On multivariate analysis risk factors associated with decreased renal function included age (HR 1.03, p <0.0001), preoperative estimated glomerular filtration rate (HR 1.05, p <0.0001), chronic hypertension (HR 1.2, p = 0.01), postoperative hydronephrosis (HR 1.2, p = 0.03), pyelonephritis (HR 1.3, p = 0.01) and ureteroenteric stricture (HR 1.6, p <0.0001). Conclusions Decreased renal function is noted in most patients during long-term followup after radical cystectomy. Postoperative hydronephrosis, pyelonephritis and ureteroenteric stricture represent potentially modifiable factors associated with a decrease. Choice of urinary diversion was not independently associated with decreased renal function.

Original languageEnglish (US)
Pages (from-to)619-625
Number of pages7
JournalJournal of Urology
Volume191
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Cystectomy
Kidney
Glomerular Filtration Rate
Urinary Diversion
Hydronephrosis
Pyelonephritis
Pathologic Constriction
Multivariate Analysis
Natural History
Hypertension

Keywords

  • chronic
  • cystectomy
  • postoperative complications
  • renal insufficiency
  • urinary bladder neoplasms
  • urinary diversion

ASJC Scopus subject areas

  • Urology

Cite this

Eisenberg, M. S., Thompson, R. H., Frank, I., Kim, S. P., Cotter, K. J., Tollefson, M. K., ... Boorjian, S. A. (2014). Long-term renal function outcomes after radical cystectomy. Journal of Urology, 191(3), 619-625. https://doi.org/10.1016/j.juro.2013.09.011

Long-term renal function outcomes after radical cystectomy. / Eisenberg, Manuel S.; Thompson, R. Houston; Frank, Igor; Kim, Simon P.; Cotter, Katherine J.; Tollefson, Matthew K.; Kaushik, Dharam; Thapa, Prabin; Tarrell, Robert; Boorjian, Stephen A.

In: Journal of Urology, Vol. 191, No. 3, 03.2014, p. 619-625.

Research output: Contribution to journalArticle

Eisenberg, MS, Thompson, RH, Frank, I, Kim, SP, Cotter, KJ, Tollefson, MK, Kaushik, D, Thapa, P, Tarrell, R & Boorjian, SA 2014, 'Long-term renal function outcomes after radical cystectomy', Journal of Urology, vol. 191, no. 3, pp. 619-625. https://doi.org/10.1016/j.juro.2013.09.011
Eisenberg MS, Thompson RH, Frank I, Kim SP, Cotter KJ, Tollefson MK et al. Long-term renal function outcomes after radical cystectomy. Journal of Urology. 2014 Mar;191(3):619-625. https://doi.org/10.1016/j.juro.2013.09.011
Eisenberg, Manuel S. ; Thompson, R. Houston ; Frank, Igor ; Kim, Simon P. ; Cotter, Katherine J. ; Tollefson, Matthew K. ; Kaushik, Dharam ; Thapa, Prabin ; Tarrell, Robert ; Boorjian, Stephen A. / Long-term renal function outcomes after radical cystectomy. In: Journal of Urology. 2014 ; Vol. 191, No. 3. pp. 619-625.
@article{e92caa9651cb4386b3ba1d023d804d6b,
title = "Long-term renal function outcomes after radical cystectomy",
abstract = "Purpose We evaluated the long-term natural history of renal function after radical cystectomy with urinary diversion and determined factors associated with decreased renal function. Materials and Methods We reviewed the records of 1,631 patients who underwent radical cystectomy between 1980 and 2006. The estimated glomerular filtration rate was calculated preoperatively and at various intervals after surgery. A renal function decrease was defined as a greater than 10 ml per minute/1.73 m2 reduction in the estimated glomerular filtration rate. Multivariate analysis was done to evaluate the association of clinicopathological features, incontinent vs continent diversion type and postoperative complications with decreased renal function. Results A total of 1,241 patients (76{\%}) underwent incontinent diversion and 390 (24{\%}) underwent continent diversion. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.1, 15.3). The median preoperative estimated glomerular filtration rate was higher in the continent diversion cohort (67 vs 59 ml per minute/1.73 m2, p <0.0001). This difference was maintained until 7 years postoperatively, after which no difference was noted in renal function by diversion type. By 10 years after radical cystectomy the risk of a renal function decrease was similar for incontinent and continent diversion (71{\%} and 74{\%}, respectively, p = 0.13). On multivariate analysis risk factors associated with decreased renal function included age (HR 1.03, p <0.0001), preoperative estimated glomerular filtration rate (HR 1.05, p <0.0001), chronic hypertension (HR 1.2, p = 0.01), postoperative hydronephrosis (HR 1.2, p = 0.03), pyelonephritis (HR 1.3, p = 0.01) and ureteroenteric stricture (HR 1.6, p <0.0001). Conclusions Decreased renal function is noted in most patients during long-term followup after radical cystectomy. Postoperative hydronephrosis, pyelonephritis and ureteroenteric stricture represent potentially modifiable factors associated with a decrease. Choice of urinary diversion was not independently associated with decreased renal function.",
keywords = "chronic, cystectomy, postoperative complications, renal insufficiency, urinary bladder neoplasms, urinary diversion",
author = "Eisenberg, {Manuel S.} and Thompson, {R. Houston} and Igor Frank and Kim, {Simon P.} and Cotter, {Katherine J.} and Tollefson, {Matthew K.} and Dharam Kaushik and Prabin Thapa and Robert Tarrell and Boorjian, {Stephen A.}",
year = "2014",
month = "3",
doi = "10.1016/j.juro.2013.09.011",
language = "English (US)",
volume = "191",
pages = "619--625",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Long-term renal function outcomes after radical cystectomy

AU - Eisenberg, Manuel S.

AU - Thompson, R. Houston

AU - Frank, Igor

AU - Kim, Simon P.

AU - Cotter, Katherine J.

AU - Tollefson, Matthew K.

AU - Kaushik, Dharam

AU - Thapa, Prabin

AU - Tarrell, Robert

AU - Boorjian, Stephen A.

PY - 2014/3

Y1 - 2014/3

N2 - Purpose We evaluated the long-term natural history of renal function after radical cystectomy with urinary diversion and determined factors associated with decreased renal function. Materials and Methods We reviewed the records of 1,631 patients who underwent radical cystectomy between 1980 and 2006. The estimated glomerular filtration rate was calculated preoperatively and at various intervals after surgery. A renal function decrease was defined as a greater than 10 ml per minute/1.73 m2 reduction in the estimated glomerular filtration rate. Multivariate analysis was done to evaluate the association of clinicopathological features, incontinent vs continent diversion type and postoperative complications with decreased renal function. Results A total of 1,241 patients (76%) underwent incontinent diversion and 390 (24%) underwent continent diversion. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.1, 15.3). The median preoperative estimated glomerular filtration rate was higher in the continent diversion cohort (67 vs 59 ml per minute/1.73 m2, p <0.0001). This difference was maintained until 7 years postoperatively, after which no difference was noted in renal function by diversion type. By 10 years after radical cystectomy the risk of a renal function decrease was similar for incontinent and continent diversion (71% and 74%, respectively, p = 0.13). On multivariate analysis risk factors associated with decreased renal function included age (HR 1.03, p <0.0001), preoperative estimated glomerular filtration rate (HR 1.05, p <0.0001), chronic hypertension (HR 1.2, p = 0.01), postoperative hydronephrosis (HR 1.2, p = 0.03), pyelonephritis (HR 1.3, p = 0.01) and ureteroenteric stricture (HR 1.6, p <0.0001). Conclusions Decreased renal function is noted in most patients during long-term followup after radical cystectomy. Postoperative hydronephrosis, pyelonephritis and ureteroenteric stricture represent potentially modifiable factors associated with a decrease. Choice of urinary diversion was not independently associated with decreased renal function.

AB - Purpose We evaluated the long-term natural history of renal function after radical cystectomy with urinary diversion and determined factors associated with decreased renal function. Materials and Methods We reviewed the records of 1,631 patients who underwent radical cystectomy between 1980 and 2006. The estimated glomerular filtration rate was calculated preoperatively and at various intervals after surgery. A renal function decrease was defined as a greater than 10 ml per minute/1.73 m2 reduction in the estimated glomerular filtration rate. Multivariate analysis was done to evaluate the association of clinicopathological features, incontinent vs continent diversion type and postoperative complications with decreased renal function. Results A total of 1,241 patients (76%) underwent incontinent diversion and 390 (24%) underwent continent diversion. Median followup after radical cystectomy in patients alive at last followup was 10.5 years (IQR 7.1, 15.3). The median preoperative estimated glomerular filtration rate was higher in the continent diversion cohort (67 vs 59 ml per minute/1.73 m2, p <0.0001). This difference was maintained until 7 years postoperatively, after which no difference was noted in renal function by diversion type. By 10 years after radical cystectomy the risk of a renal function decrease was similar for incontinent and continent diversion (71% and 74%, respectively, p = 0.13). On multivariate analysis risk factors associated with decreased renal function included age (HR 1.03, p <0.0001), preoperative estimated glomerular filtration rate (HR 1.05, p <0.0001), chronic hypertension (HR 1.2, p = 0.01), postoperative hydronephrosis (HR 1.2, p = 0.03), pyelonephritis (HR 1.3, p = 0.01) and ureteroenteric stricture (HR 1.6, p <0.0001). Conclusions Decreased renal function is noted in most patients during long-term followup after radical cystectomy. Postoperative hydronephrosis, pyelonephritis and ureteroenteric stricture represent potentially modifiable factors associated with a decrease. Choice of urinary diversion was not independently associated with decreased renal function.

KW - chronic

KW - cystectomy

KW - postoperative complications

KW - renal insufficiency

KW - urinary bladder neoplasms

KW - urinary diversion

UR - http://www.scopus.com/inward/record.url?scp=84893871949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84893871949&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2013.09.011

DO - 10.1016/j.juro.2013.09.011

M3 - Article

C2 - 24036234

AN - SCOPUS:84893871949

VL - 191

SP - 619

EP - 625

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 3

ER -