Oncologic and Renal Function Outcomes After Radical Cystectomy and Ureterocutaneostomy: A Single Center Experience

Şevket Tolga Tombul, Gökhan Sönmez, Abdullah Demirtaş, Atila Tatlışen
2019 Journal of Urological Surgery  
Objective: It is aimed to present the long-term oncologic and nephrological follow-up results in patients who underwent radical cystectomy and ureterocutaneostomy (RC+UC) due to localized muscle-invasive bladder cancer (MIBC). Materials and Methods: A total of 83 patients diagnosed with localized MIBC (age ≥70 years or an American Society of Anesthesiologists score ≥3), who underwent RC+UC between January 1995 and June 2013, were evaluated retrospectively. Patients who died due to postoperative
more » ... ue to postoperative early surgical complications and patients with a preoperative glomerular filtration rate (GFR) <50 mL/(min×m 2 ), a solitary kidney, another malignancy, a dialysis history, and patients without a follow-up information record were excluded. Results: The median age of the patients was 71 years. Seventy-three (88%) were male. Distant organ metastasis was detected in 33 patients. Thirtyone (37.3%) patients died of causes other than cancer, 35 (42.2%) died from cancer progression, and 17 (20.5%) survived. Preoperatively, 38 had hydroureteronephrosis (HUN) in one or both kidneys and 6 had undergone preoperative urinary diversion. Sixty-three (75.9%) patients had stoma stenosis, and they were followed with ureteral stents. The number of patients requiring permanent dialysis due to postrenal acute renal failure was 5 (6%). A significant difference was observed between the preoperative, first-and third-year GFR levels in 52 patients having at least a 3-year follow-up period. The change in GFR was found to be 32% after 3 years of follow-up in these patients. The decrease in GFR was more prominent in patients with preoperative HUN. Conclusion: RC+UC should be considered as an option in carefully selected patients in whom the risk of renal function loss is acceptable in terms of age, comorbidity, and life expectancy. Amaç: Bu çalışmada, kasa invazyon gösteren lokalize mesane kanseri (KİMK) nedeniyle uygulanan radikal sistektomi ve üreterokutaneostomi (RS+ÜK) uygulanan hastaların uzun dönem onkolojik ve böbrek fonksiyonu takip sonuçlarının sunulması amaçlanmıştır. Gereç ve Yöntem: Ocak 1995-Haziran 2013 arasında KİMK tespit edilen, 70 yaş ve üzeri veya Amerikan Anestezi Uzamanları Derneği skoru 3 ve üzeri olması nedeniyle RS+ÜK ameliyatı yapılmış 83 hastanın verileri retrospektif olarak değerlendirilmiştir. Preoperatif glomerüler filtrasyon hızı (GFR) <50 mL/(min×m 2 ) olan, soliter böbrekli olan, başka bir malignitesi olan, diyaliz öyküsü olanlar, takip verileri olmayan, postoperatif erken cerrahi komplikasyonlara bağlı exitus olan hastalar çalışma dışı bırakılmıştır. Hastaların demografik, onkolojik ve neforlojik verileri kaydedilmiştir. Bulgular: Çalışmaya dahil edilen 83 hastanın ortanca yaşı 71 yıldı. Hastaların 73'ü (%88) erkek, 10'u (%12) ise kadındı. Otuz üç hastada uzak organ Abstract Öz What's known on the subject? and What does the study add? Ureterocutenoustomy is not a preferred urinary diversion after radical cystectomy. But sometimes urologists have to chose this diversion most probably due to patient related factors. We believe that this is one of the largest ureterocutenoustomy series in Turkiye and will contribute to the literature.
doi:10.4274/jus.galenos.2019.2682 fatcat:p7xmc7cd5bfdrlzibsfxu3czua