Risk assessment of chronic kidney disease development in patients undergone robotic radical cystectomy and totally
INTRODUCTION AND OBJECTIVES: In the last few years robotic radical cystectomy (RRC) for muscle invasive bladder cancer began to gain popularity. Anyway, total intracorporeal diversion is a challenging procedure. In this series we presented the risk assessment of chronic kidney disease (CKD) development in our first 100 patients treated with RRC and intracorporeal urinary diversion.
METHODS: From October 2012 to September 2014, 100 consecutive unselected patients with cT2-4a/cN1-3/cM0 bladder cancer underwent RRC, extended lymphadenectomy and totally intracorporeal diversion. Baseline demographics, perioperative and follow up data were prospectively collected. Univariable and multivariable cox analysis were performed to identify independent predictors of increased risk of CKD development.
RESULTS: Out of 100 RRC, we selected 87 consecutive patients with at least a 3-month follow up. Sixty-nine patients received a Padua Ileal bladder (54 male and 15 female), while 18 patients received an ileal conduit. Nineteen patients underwent neoadjuvant chemotherapy (21.8%). At a median follow up of 11 months [interquartile range (IQR): 7–16 mo], 17 (19.5%) patients experienced IIIb-IV stage CKD. A 2-3 grade hydronephrosis occurred in 11 of the 17 patients with renal function deterioration. All these patients were successfully treated with antegrade ureteral stenting. At univariable analysis age, gender, BMI, preoperative eGFR, urinary diversion and neoadjuvant chemotherapy (all p < 0.001) were associated with an increased risk of CKD development. At multivariable analysis, the only independent predictor of renal function deterioration was preoperative eGFR (p = 0.003; HR: 0.93 [95% CI, 0.88–0.97]). CONCLUSIONS: RRC with totally intracorporeal urinary diversion is feasible and safe. A strict follow up, especially in patients with pre-existing renal deterioration, is recommended to early identify and promptly treat complications in order to protect upper urinary tract and preserve renal function. ==fine abstract==