U J All Final for WEB.pdf
784 | Urological Oncology
Takahiro Osawa,1 Nobuo Shinohara,1 Satoru Maruyama,1 Koji Oba,2 Takashige Abe,1 Shintaro Maru,1 Norikata Takada,1
Ataru Sazawa,1 Katsuya Nonomura1
Long-Term Renal Function Outcomes in
Bladder Cancer After Radical Cystectomy
Corresponding Author:
Nicholas G. Cost, MD
Division of Pediatric Urology, Cincin-
nati Children’s Hospital Medical
Center, 3333 Burnet Avenue, MLC
5037, Cincinnati, Ohio 45229, USA
Tel: +513 363 0773
Fax: +513 636 6753
E-mail: nicholas.cost@sbcglobal.net
Received January 2012
Accepted October 2012
UROLOGICAL ONCOLOGY
Corresponding Author:
Nicholas G. Cost, MD
Division of Pediatric Urology, Cinci
nati Children’s Hospital Medical
Center, 3333 Burnet Avenue, MLC
5037, Cincinnati, Ohio 45229, USA
Tel: +513 363 0773
Fax: +513 636 6753
E-mail: nicholas.cost@sbcglobal.n
Received January 2012
Accepted October 2012
1Department of Urology,
Hokkaido University Grad-
uate School of Medicine,
Sapporo, Japan
2Translational Research
and Clinical Trial Center,
Hokkaido University Hospi-
tal, Sapporo, Japan
Corresponding Author:
Takahiro Osawa, MD
Department of Renal and
Genitourinary Surgery,
Hokkaido University Grad-
uate School of Medicine,
North-15, West-7, North
Ward, Sapporo, 060-8638,
Japan
Tel: +81 117 161 161 (Ext.)
5949
Fax: +81 117 067 853
E-mail: taka0573@gmail.
com
Received March 2012
Accepted October 2012
Purpose: To evaluate postoperative renal function and risk factors for the loss of renal function in
Materials and Methods: -
-
-
tion, type of urinary diversion, the postoperative occurrence of acute pyelonephritis, and the pres-
ence of chemotherapy.
Results: 2 before surgery and 63.6
2
-
P -
P
Conclusion:
Keywords:
cystectomy
785Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L
INTRODUCTION
Urinary diversion is inevitable during radical cys-and high-grade non-muscle invasive bladder can-
-
tion of the bladder is that it should not jeopardize the function
of the upper urinary tract. To achieve long-term upper urinary
discussed.
-
-
-
considered to be the better measure of overall kidney func-
function after partial nephrectomy and renal transplantation.
(2,3)
-
tion and the risk factors for the loss of renal function in pa-
MATERIALS AND METHODS
-
-
-
-
-
Before the selection of the urinary diversion, a thorough eval-
continent urinary diversions as it leads to an inability to com-
pensate for metabolic disturbances. The indications for
-
-
the ileocecal reservoir are its large initial volume and its il-
procedure has not been performed in our institution since
vitamin B
-
-
m2 -
nese Society of Nephrology.(6) -
pre-operative renal function.
hypertension or diabetes mellitus, pre-operative renal func-
tion, type of urinary diversion, the presence of chemotherapy,
and the repeated postoperative episode of acute pyelonephri-
-
colony-forming units) and the pres-
Renal Function After Radical Cystectomy | Osawa et al
786 |
-
glycemic control.
estimated using the Kaplan-Meier method, and distribu-
Cary, North Carolina, USA). P -
RESULTS
-
2
2 2
2
-
-
ing to the type of diversion. Both cutaneous diversion and
Furthermore, surgical intervention, including balloon ure-
-
P
(P
2 patients from three APN, and 2 patients from more than
-
urinary diversion.
The peri-operative chemotherapy regimens used in the cur-
-
-
-
Urological Oncology
Figure 1. Kaplan–Meier curve of the renal deterioration-free inter-
val of all the patients.
The 10-year renal deterioration-free interval was 63.8%.
Figure 2. Kaplan–Meier curve of the renal deterioration-free in-
terval by the repeated acute pyelonephritis episode in univariate
Log-Rank analysis.
P
ro
p
o
rt
io
n
(
%
)
Months Months
P
ro
p
o
rt
io
n
(
%
)
787Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L
of 3 in the other chemotherapy group. On the other hand,
among chemotherapy courses.
P
P
pre-operative eGFR, the type of urinary diversion, diabetes
function outcomes (Table 2).
DISCUSSION
Urinary diversion is mandatory for patients undergoing
is critical for evaluating urologic reconstructive procedures.
-
-
-
This result is comparable to the results of a previous study
In general, renal function is favorably preserved after con-
urinary diversion, and the incidence of renal deterioration
after continent urinary diversion has been reported to range
-
concentrated on serial serum creatinine measurements as an
indicator of early renal impairment.
Fontaine and colleagues evaluated GFR pre-operatively in
-
Therefore, the up-
report.
-
cant predictor of renal deterioration in our series. The MVAC
Table 1. Characteristics of patients stratified according to the type of urinary diversion that they underwent.
Variables Cutaneous ureterostomy Ileal conduit Ileal neobladder Ileocecal neobladder P
Patients, n 9 25 24 12
Age, >75/<75 y 5/4 5/20 1/23 0/12 <.01
Gender, male/female 6/3 20/5 19/5 9/3 .86
Pre-operative eGFR,*
>60/<60 mL/min/1.73 m2
3/6 21/4 21/3 12/0 .01
Chemotherapy, +/- 3/6 8/17 6/18 5/7 .78
Acute pyelonephritis,
>2/<2 times
2/7 2/23 7/17 1/11 .19
Ureteral obstruction,+/- 1/8 5/20 0/24 1/11 .14
Diabetes mellitus,+/- 3/6 3/22 3/21 0/12 .16
Hypertension, +/- 4/5 9/16 2/22 1/11 .03
*eGFR indicates estimated serum creatinine-based glomerular filtration rate.
Renal Function After Radical Cystectomy | Osawa et al
788 |
is the standard chemotherapy regimen for metastatic urothe-
lial cancer.
-
verse effects compared to the MVAC. We use the PIN,
standard cisplatin-based chemotherapy. Cisplatin is a po-
tent chemotherapy agent that is used to treat a broad spec-
trum of malignancies, but it causes renal tubular dysfunction
and a cumulative impairment of renal function, as manifested
by a decline in the GFR.
-
py. In cases involving relapse or metastasis, patients often
multimodal treatment strategies incorporating peri-operative
When chemotherapy is employed, it is necessary to take the
-
icity by forced hydration and diuresis.
-
lent risk factor for renal deterioration. Samuel and associates
Our
-
peri-operative episode of APN might be prevented by antibi-
peri-operative use of antibiotics. On the other hand, APN in
P
diversions.
-
of urinary diversion. The limitations of this study include its
retrospective design, small patient population in each type
-
sions. Furthermore, different surgeons performed the pro-
CONCLUSION
-
Table 2. Results of multivariate analysis.*
Variable Hazard Ratio (95% CI) P
Age, every 10 years 1.17 (0.78 to 1.76) .44
Gender, female 1.40 (0.45 to 4.29) .56
Pre-operative eGFR,< 60 mL/min/1.73 m2 0.77 (0.24 to 2.44) .66
Urinary diversion (Compared to Ileal neobladder) .39
Cutaneous ureterostomy 0.30 (0.05 to 1.78)
Ileal conduit 1.00 (0.32 to 3.15)
Ileocecal neobladder 0.45 (0.10 to 2.01)
Chemotherapy 3.27 (1.33 to 8.01) .01
Acute pyelonephritis,>2 times 3.21 (1.14 to 9.02) .03
Diabetes mellitus 1.78 (0.48 to 6.57) .39
Hypertension 0.40 (0.10 to 1.59) .19
*CI indicates confidence interval; and eGFR estimated serum creatinine-based glomerular filtration rate.
Urological Oncology
789Vol. 10 | No. 1 | Winter 2013 |U R O LO G Y J O U R N A L
Renal Function After Radical Cystectomy | Osawa et al
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ence in renal deterioration among the four types of urinary
urinary diversion, ie, the postoperative episode of repeated
function.
CONFLICT OF INTEREST
None declared.