Table 1.
Clinical and pathological patient characteristics.
Fig 1.
Patient selection and study design.
We performed radical cystectomy and urinary diversion in 345 consecutive adult patients in our hospital. Of these, 115 patients with more than a 5-year follow-up were identified. Forty-seven patients were included the incontinent diversion group (ileal conduit or cutaneous ureterostomy), and 68 were included in the continent group (orthotopic ileal neobladder). Sixty-eight of these patients (n = 34 each) were selected using the propensity score matching method.
Table 2.
Renal function before and after surgery.
Fig 2.
Pre- and postoperative renal function in all patients.
The eGFR decline curve showed that pre- and postoperative eGFR were significantly lower in the incontinent group than in the continent group (unpaired t-test) (a). The proportion of patients with pre- and postoperative stage 3 CKD (eGFR < 60 mL/min/1.72 m2) was significantly different between the groups (Fisher’s exact test) (b).
Fig 3.
Pre- and postoperative renal function in propensity score-matched patients.
No significant differences were observed in pre- and postoperative renal function after the 5-year follow-up (a). The proportion of patients with pre- and postoperative stage 3 CKD (eGFR < 60 mL/min/1.72 m2) was not significantly different between the groups (Fisher’s exact test) (b). A waterfall plot showed no significant differences in 5-year eGFR decrease rates after urinary diversion between the groups (unpaired t-test, P = 0.6499) (c). The proportion of patients with preoperative stage 3B CKD (eGFR < 45 mL/min/1.72 m2) was not significantly different between the groups; however, a significant difference was observed in the proportion of patients with postoperative stage 3B CKD in the incontinent group (Fisher’s exact test) (d).
Table 3.
Multivariate Cox regression analyses of risk factors for postoperative stage 3B CKD (eGFR < 45 mL/min/1.73 m2).
Incontinent urinary diversion was divided into 2 groups, and compared with orthotopic ileal neobladder in the model 2. Comorbidities included past history of CVD, HTN, or DM.
Fig 4.
Stage 3B CKD-free interval rates in propensity score-matched patients.
The Kaplan–Meier curve showed that 5-year stage 3B CKD-free interval rates were significantly higher in the continent group (84%) than in the incontinent group (58%) (Log-rank test).
Fig 5.
Pre- and postoperative renal function in propensity score-matched patients among 3 types of urinary diversion.
Cutaneous ureterostomy showed tendency of renal function decline compared with other urinary diversion, although there were no significant differences in pre- and postoperative renal function after the 5-year follow-up (P = 0.473, One-way ANOVA analysis).