Does urinary diversion type influence long-term renal outcomes after radical cystectomy? A multicenter retrospective study.

Abstract

728 Background: Long-term renal function decline is a known complication following urinary diversion, and its etiology is considered multifactorial, involving factors such as preoperative renal function, comorbidities, and postoperative complications. While previous studies have explored general risk factors for renal deterioration, the specific impact of different urinary diversion techniques on long-term renal outcomes remains unclear. Methods: This multicenter retrospective study analyzed 702 patients who underwent radical cystectomy (RC) and urinary diversion. Patients were categorized into three groups based on the type of urinary diversion: cutaneous ureterostomy, ileal conduit, and ileal neobladder. Major adverse kidney events (MAKE), defined as a ≥50% decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, or eGFR ≤15 mL/min/1.73 m 2 , were used as indicators of renal prognosis. Events were considered present if criteria were met on two consecutive occasions at least three months apart. Multivariable Cox proportional hazards regression analysis was performed to evaluate the impact of urinary diversion type on MAKE-free survival. Results: The median age was 70 years, and the median follow-up duration was 48 months. Of the 702 patients, 219 (31%) underwent cutaneous ureterostomy, 123 (18%) ileal conduit, and 360 (51%) ileal neobladder. eGFR at 5, 7, and 10 years after RC differed significantly among the three groups ( P < 0.001 for all time points). Chronic kidney disease-free survival was significantly longer in the ileal neobladder group compared to both the cutaneous ureterostomy group ( P = 0.012) and the ileal conduit group ( P = 0.024). MAKE occurred in 121 patients (17%). After adjusting for confounding variables, no significant difference in MAKE-free survival was observed between the cutaneous ureterostomy and ileal conduit groups. However, the ileal neobladder group had a significantly lower risk of MAKE compared to the cutaneous ureterostomy group ( P = 0.014; hazard ratio: 0.518; 95% confidence interval: 0.307–0.876). Conclusions: The type of urinary diversion significantly affects long-term renal function. These findings may be useful in guiding surgical decision-making and predicting renal outcomes following urinary diversion. Multivariable analysis for MAKE-free survival. Factor P value HR 95% CI Age Continuous 0.992 1.00 0.97–1.03 Sex Male 0.469 0.84 0.53–1.34 PS Continuous 0.603 1.15 0.69–1.92 BMI Continuous 0.011 1.09 1.02–1.16 Hypertension Presence 0.222 1.32 0.85–2.05 Dislipidemia Presence 0.145 1.46 0.88–2.42 DM Presence 0.703 1.10 0.67–1.83 Preoperative eGFR Continuous 0.421 0.99 0.98–1.01 Hydronephrosis Presence 0.138 0.64 0.35–1.16 Grade of hydronephrosis Continuous <0.001 1.56 1.27–2.02 Type of urinary diversion Ureterostomy Ref. Conduit 0.995 0.99 0.57–1.75 Neobladder 0.014 0.52 0.31–0.88