Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Int J Urol. 2022 Feb;29(2):158-163. doi: 10.1111/iju.14747. Epub 2021 Dec 8.
To analyze the long-term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion.
We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal conduit patients were matched in a 1:2 ratio and a propensity score-matched analysis was carried out. Data were summarized using descriptive analysis. Trend plots were generated using baseline and follow-up creatinine values to compare estimated glomerular filtration rate at 3 months, then annually for 5 years. Variables associated with estimated glomerular filtration rate were assessed using multivariate linear analysis.
Our cohort consisted of 137 patients (neobladder n = 50 and ileal conduit n = 87) with a median follow-up time of 3 years (interquartile range 1-7 years). The ileal conduit group had shorter operative times (352 vs 444 min, P < 0.01), intracorporeal diversions were more common (66% vs 44%, P = 0.01), had prior abdominal surgery (66% vs 38%, P < 0.01) and had radiation (9% vs 0%, P = 0.03). The neobladder group more commonly had recurrent urinary tract infections (22% vs 3%, P < 0.01) and a steeper decrease in estimated glomerular filtration rate in the first year. On multivariate linear analysis, age/year (-0.59), body mass index per kg/m (-0.52), preoperative estimated glomerular filtration rate per unit (0.51), recurrent urinary tract infections (-14.03) and time versus day 90 (year 1, -7.52; year 2, -9.06; year 3, -10.78) were significantly associated with estimated glomerular filtration rate.
Ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot-assisted radical cystectomy. Recurrent urinary tract infections were associated with a worse estimated glomerular filtration rate.
分析可控（新膀胱）与不可控（回肠导管）尿流改道对长期的影响。
我们对科室数据库进行了回顾性分析。使用慢性肾脏病流行病学协作公式计算估计肾小球滤过率。新膀胱和回肠导管患者以 1:2 的比例匹配，并进行倾向评分匹配分析。使用描述性分析总结数据。生成趋势图，使用基线和随访肌酐值比较 3 个月、然后每年比较 5 年的估计肾小球滤过率。使用多元线性分析评估与估计肾小球滤过率相关的变量。
我们的队列包括 137 名患者（新膀胱组 n=50，回肠导管组 n=87），中位随访时间为 3 年（四分位间距 1-7 年）。回肠导管组的手术时间更短（352 分钟 vs 444 分钟，P<0.01），腔内转流更常见（66% vs 44%，P=0.01），有既往腹部手术史（66% vs 38%，P<0.01）和放疗史（9% vs 0%，P=0.03）。新膀胱组更常见复发性尿路感染（22% vs 3%，P<0.01），且在第一年估计肾小球滤过率下降更明显。多元线性分析显示，年龄/年（-0.59）、体重指数/kg/m（-0.52）、术前估计肾小球滤过率单位（0.51）、复发性尿路感染（-14.03）和时间与第 90 天（第 1 年，-7.52；第 2 年，-9.06；第 3 年，-10.78）与估计肾小球滤过率显著相关。
在机器人辅助根治性膀胱切除术后 5 年内，回肠导管和新膀胱对估计肾小球滤过率的影响相似。复发性尿路感染与估计肾小球滤过率下降有关。
