Comparison of postoperative acute kidney injury between ileal conduit and neobladder urinary diversions after radical cystectomy

Abstract

Ileal conduit and neobladder urinary diversions are frequently performed after radical cystectomy. However, complications after radical cystectomy may be different according to the type of urinary diversion. Acute kidney injury (AKI) is a common complication after surgery and increases costs, morbidity, and mortality of hospitalized patients. This study was performed to compare the incidence of postoperative AKI between ileal conduit and neobladder urinary diversions after radical cystectomy.All consecutive patients who underwent radical cystectomy in 2004 to 2014 in a single tertiary care center were identified. The patients were divided into the ileal conduit and ileal neobladder groups. Preoperative variables, including demographics, cancer-related data and laboratory values, as well as intraoperative data and postoperative outcomes, including AKI, intensive care unit admission rate, and the duration of hospital stay, were evaluated between the groups. Postoperative AKI was defined according to the Kidney Disease: Improving Global Outcome criteria. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences.After performing 1:1 propensity score matching, the ileal conduit and ileal neobladder groups each included 101 patients. The overall incidence of AKI after radical cystectomy was 30.7% (62 out of 202) and the incidences did not significantly differ between the groups (27 [26.7%], ileal conduit group vs 35 [34.7%], ileal neobladder group, P = 0.268). Intraoperative data, intensive care unit admission rate, and the duration of hospital stay were not significantly different between the groups.Postoperative AKI did not significantly differ between ileal conduit and neobladder urinary diversions after radical cystectomy. This finding provides additional information useful for appropriate selection of the urinary diversion type in conjunction with radical cystectomy.

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

“…Renal dysfunction can occur after both types of urinary diversions in patients undergoing radical cystectomy. However, most previous studies did not compare the change in renal function between the two types of urinary diversions and evaluated mainly only early renal outcomes such as acute kidney injury [ 11 , 30 , 31 , 32 ]. Therefore, little is known about the comparison of renal function at 12 months postoperatively between ileal conduit urinary diversion and ileal neobladder urinary diversion.…”

C-reactive Protein/Albumin Ratio and Acute Kidney Injury after Radical Cystectomy among Elderly Patients: A Propensity Score-Matched Analysis

“…The rates of complications, morbidity, and mortality associated with radical cystectomy are high among elderly patients [3]. In particular, postoperative acute kidney injury (AKI) is common after radical cystectomy and is associated with increased hospital stay durations, healthcare costs, and mortality [4]. Elderly patients are at the highest risk for AKI and AKI-associated mortality [5].…”

Long-term outcome of spiral ileal neobladder with orthotopic ureteral reimplantation

“…Although previous studies have revealed that patients undergoing ileal neobladder surgery had better QoL than those who underwent ileal conduit [4], most of the patients who chose neobladder were younger and had less severe illness [5]. Because very few randomized controlled trials have compared the advantages of ileal neobladder surgery and traditional ileal conduit, it remains controversial whether the long-term QoL and renal function of patients after ileal neobladder surgery are better than those after traditional ileal conduit [6]. Moreover, the indications for ileal neobladder surgery are strictly limited, and the cardiopulmonary function, blood glucose level, intestinal health status, and compliance of patients need to be strictly screened before treatment.…”