Publication:

Renal dysfunction following ileal conduit urinary diversions after radical cystectomy: a five year follow-up study

Background Ileal conduit (IC) is the most commonly performed urinary diversions (UD) contributing 33-72 % of all types of UD with. Ileal conduits are relatively easy and quick to create, with a low rate of surgical complications. However, there is an incidence of renal deterioration was comparatively high following radical cystectomy, irrespective of the type of UD. To this purpose, we evaluated the post-operative renal function and non-surgical risk factors for loss of renal function in patients who underwent radical cystectomy with ICUD.

Methods In this retrospective single institutional study, we evaluated risk factors for loss of renal function in 45 patients who had undergone radical cystectomy with ileal conduit as the sole form of urinary diversion. Renal function was calculated based on e-GFR. Analysed risk factors were age, gender, hypertension, diabetes, preoperative renal function, the post-operative occurrence of acute pyelonephritis and chemotherapy.

Results There were 30 males and 15 female patients; the median follow-up was 36 months (3-90 months). The mean e-GFR before surgery was 74.2 (22.7-143.7) ml/min/1.73 m2, and it was 58.6 (8.2-140.9) ml/min/1.73 m2 after surgery, at last, follow up. Five-year renal deterioration free interval was 63.8%. Multivariate analysis showed that post-operative occurrence of acute pyelonephritis (p=0.0003) and treatment with chemotherapy (p <0.000) were significant risk factors for loss of renal function.

Conclusions In our study, 13/45 (28.8%) patients demonstrated a reduction in renal function during the follow-up period. Postoperative episodes of acute pyelonephritis and treatment with chemotherapy were found to be significant risk factors.