Long-term Changes in Renal Function, Blood Electrolyte Levels, and Nutritional Indices after Radical Cystectomy and Ileal Conduit in Patients with Bladder Cancer

Makito Miyake, Takuya Owari, Mitsuru Tomizawa, Masaru Matsui, Naoko Nishibayashi, Kota Iida, Kenta Onishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yoshitaka Itami, Yasushi Nakai, Takeshi Inoue, Satoshi Anai, Kazumasa Torimoto, Katsuya Aoki, Nobumichi Tanaka, Kiyohide Fujimoto



Purpose: To assess the long-term changes in renal function, blood electrolyte levels, and nutritional indices after radical cystectomy and ileal conduit in patients with bladder cancer.

Patients and Methods: In 129 patients who underwent radical cystectomy and ileal conduit, we evaluated clinicopathologic features, complications, and the change in the estimated glomerular filtration rate (eGFR) from baseline to 1, 2, 3, 4, 5, and 10 years postoperatively. Two nutritional indices, the geriatric nutritional risk index (GNRI) and prognostic nutrition index (PNI), were calculated with laboratory tests. The Student t-test, Mann-Whitney U test, paired t-test, or Wilcoxon’s signed-rank test was used, as appropriate.

Results: In the ileal conduit group, a parastromal hernia was observed in 10% of patients, whereas 13% had an ureteroenteric anastomotic stricture, which was associated with greater decline in the eGFR postoperatively. The first 5 year-decline in the eGFR was 1.74 mL/min/1.73 m2/year. The levels of only potassium showed a significant increase at 1 year postoperatively (mean: 4.34 mEq/L) and remained high compared with the baseline (4.14). Evaluation of the nutritional indices demonstrated that the GNRI, not PNI, showed a significant, transient increase from 1 to 4 years (range: 108?110) postoperatively compared with the baseline (105).

Conclusion: The first 5 year-decline was much higher than that among Japanese individuals who participated in an annual health examination program. Further research should be performed to identify an appropriate strategy for selecting the suitable type of urinary diversion and postoperative nutritional interventions to improve the clinical outcome of patients with bladder cancer.

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Witjes JA, Compérat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2014; 65: 778-92.

Miyake M, Morizawa Y, Hori S, et al. Integrative Assessment of Pretreatment Inflammation-, Nutrition-, and Muscle-Based Prognostic Markers in Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy. Oncology 2017; 93: 259-69.

Miyake M, Fujimoto K, Hirao Y. Active surveillance for nonmuscle invasive bladder cancer. Investig Clin Urol 2016; 57: S4-13.

Miyake M, Gotoh D, Shimada K, et al. Exploration of risk factors predicting outcomes for primary T1 high-grade bladder cancer and validation of the Spanish Urological Club for Oncological Treatment scoring model: Long-term follow-up experience at a single institute. Int J Urol 2015; 22: 541-7.

Bochner B, Dalbagni G, Daneshmand S, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int 2014; 113: 11-23.

Alfred Witjes J, Lebret T, Compérat EM, et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017; 71: 462-75.

Bricker EM. Bladder substitution after pelvic evisceration. Surg Clin North Am 1950; 30: 1511-21.

Cordonnier JJ, Nicolai CH. An evaluation of the use of an isolated segment of ileum as a means of urinary diversion. J Urol 1960; 83: 834-8.

Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009; 55: 164-74.

Shimko MS, Tollefson MK, Umbreit EC, Farmer SA, Blute ML, Frank I. Long-term complications of conduit urinary diversion. J Urol 2011; 185: 562-7.

Canter D, Viterbo R, Kutikov A, et al. Baseline renal function status limits patient eligibility to receive perioperative chemotherapy for invasive bladder cancer and is minimally affected by radical cystectomy. Urology 2011; 77: 160–5.

Nishikawa M, Miyake H, Yamashita M, Inoue TA, Fujisawa M. Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol 2014; 19: 1105-11.

Eisenberg MS, Thompson RH, Frank I, et al. Long-term renal function outcomes after radical cystectomy. J Urol 2014; 191: 619-25.

Osawa T, Shinohara N, Maruyama S, et al. Long-term renal function outcomes in bladder cancer after radical cystectomy. Urol J 2013; 10:784-9.

Hatakeyama S, Koie T, Narita T, et al. Renal Function Outcomes and Risk Factors for Stage 3B Chronic Kidney Disease after Urinary Diversion in Patients with Muscle Invasive Bladder Cancer. PLoS One 2016; 11: e0149544.

Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009; 53: 982–92.

Levey AS, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney int 2011; 80: 17–28.

Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173: 676-82.

Narumi T, Arimoto T, Funayama A, et al. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013; 62: 307-13.

Sundi D, Svatek RS, Nielsen ME, Schoenberg MP, Bivalacqua TJ. Extent of pelvic lymph node dissection during radical cystectomy: is bigger better? Rev Urol. 2014; 16: 159-66.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13.

Imai E, Horio M, Yamagata K, et al. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res 2008; 31: 433-41.

Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol 2004; 22: 157–67.

Aquina CT, Iannuzzi JC, Probst CP, et al. Parastomal hernia: a growing problem with new solutions. Dig Surg 2014; 31: 366-76.

Imai E, Horio M, Watanabe T, et al. Prevalence of chronic kidney disease in the Japanese general population. Clinical and experimental nephrology 2009; 13: 621–30.

Gershman B, Eisenberg MS, Thompson RH, et al. Comparative impact of continent and incontinent urinary diversion on long-term renal function after radical cystectomy in patients with preoperative chronic kidney disease 2 and chronic kidney disease 3a. Int J Urol 2015; 22: 651–6.

Krajewski W, Piszczek R, Krajewska M, Dembowski J, Zdrojowy R. Urinary diversion metabolic complications - underestimated problem. Adv Clin Exp Med 2014; 23: 633-8.

Van der Aa F, Joniau S, Van Den Branden M, Van Poppel H. Metabolic changes after urinary diversion. Adv Urol 2011; 2011: 764325.

Tanrikut C, McDougal WS. Acid-base and electrolyte disorders after urinary diversion. World J Urol 2004; 22: 168-71.

Miyake M, Morizawa Y, Hori S, et al. Clinical impact of postoperative loss in psoas major muscle and nutrition index after radical cystectomy for patients with urothelial carcinoma of the bladder. BMC Cancer 2017; 17: 237.

DOI: http://dx.doi.org/10.22037/uj.v0i0.4531

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