Comparison of complications and analysis of factors affecting renal function decline after laparoscopic radical cystectomy with different urinary diversion methods
10.3760/cma.j.issn.0254-9026.2023.07.012
- VernacularTitle:根治性膀胱全切术后不同尿流改道方式的并发症比较和肾功能下降影响因素分析
- Author:
Bin JIN
1
;
Zhengtong LYU
;
Jibo JING
;
Pengjie WU
;
Yuan YUAN
;
Hong MA
;
Xin CHEN
;
Jinfu WANG
;
Yaoguang ZHANG
;
Ming LIU
Author Information
1. 北京医院泌尿外科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Keywords:
Urinary bladder neoplasms;
Cystectomy;
Urinary diversion;
Postoperative complications;
Renal insufficiency
- From:
Chinese Journal of Geriatrics
2023;42(7):815-820
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the complications associated with various urinary flow diversion methods and identify the factors that contribute to the decline in renal function after radical total cystectomy for myoinfiltrating urothelial carcinoma.Methods:This study conducted a retrospective analysis on the clinical data of 46 patients with pathologically confirmed muscle-invasive bladder cancer.The patients underwent laparoscopic radical cystectomy with either ileal conduit diversion(n=21)or ureterocutaneous diversion(n=25)between January 2017 and December 2021.Perioperative data, postoperative pathology, postoperative complications, and follow-up results were compared between the two groups.Results:The study found significant differences between the two groups in terms of age[(67±6)years vs.(73±8)years, t=3.132, P=0.003], Charlson comorbidity index adjusted for age[(3.80±1.15) vs.(4.52±1.03), t=2.223, P=0.031], prognostic nutritional index[(48.81±5.74) vs.(43.64±4.74), t=3.347, P=0.002], operation time[(449±108)minutes vs.(326±130)minutes, P=0.001]], hospital stay[(20.1±11.1)days vs.(13.3±5.2)days, t=2.762, P=0.008], proportion of Clavien grade 3 or higher complications within 3 months after surgery(4/21 vs 0/25, χ2=2.105, P<0.05), and proportion of stoma-free patients(18/21 vs.5/25, χ2=6.373, P<0.01). According to Logistic multivariate analysis, perioperative blood transfusion and urinary tract infection were identified as independent risk factors for renal function decline 12 months after surgery.Escherichia coli was found to be the most common bacteria cultured from urinary tract infections in both groups after surgery. Conclusions:Laparoscopic radical cystectomy with ureterocutaneous diversion offers benefits such as shorter hospital stays and fewer perioperative complications for older and frail patients.However, a higher proportion of patients may require ureteral stenting.It is important to note that perioperative blood transfusion and urinary tract infection are major risk factors for renal function decline following radical cystectomy.
