Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

Osman, Yasser; Harraz, Ahmed M.; El-Halwagy, Samer; Laymon, Mahmoud; Mosbah, Ahmed; Abol‐Enein, Hassan; Shaaban, A.

doi:10.1590/s1677-5538.ibju.2017.0283

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Osman Y et al reported that acute kidney injury developed in 46 (4.7%), patients after radical cystectomy. While 11 (1.1%), patients developed progressive deterioration of renal function [14].…”

Section: Discussionmentioning

confidence: 94%

Short Term Complications post Radical Cystectomy South Egypt Cancer Institute: 5 years’ experience

2021

SECI Oncology Journal

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Background: Despite advances of surgical technique and perioperative management, radical cystectomy has been associated with a substantial risk of postoperative morbidity and mortality with variable rates of short-term complications and mortality. However, with meticulous patient selection, perioperative management and surgical procedures, it currently has acceptable low perioperative mortality rate and a low rate of complications which are manageable. The aim of this study was to define the surgical outcome of radical cystectomy for urinary bladder cancer management in the point of postoperative morbidities and mortalities related to different surgical procedures aiming to minimize them to achieve the best outcomes possible. Method: This is a retrospective study of 456 patients who had underwent radical cystectomy at South Egypt Cancer Institute between a time period from January 2012 till December 2016, the data were collected from archive and cancer registration data base of surgical oncology department. Results: The age of presentation was 57.7 ± 9.4 ranged from 34 to 87 years. Male to female ratio was 71.7%., 28.3% respectively. Sixteen percent of patients were hypertensive, 13.2% diabetic and 19.7% had liver cirrhosis. The average duration of hospital stay was 14.6±6.2 days and average operative time (hour) was 4.3±1.4 hours. Most of patients (3/5 th ) showed backpressure on kidneys (63.2%). The commonest diversion performed after radical cystectomy was ileal conduit diversion (39%) then ureterocolic diversion (30.9%), followed by orthotopic diversion (14.9%) and ureterocutenous diversion (12.9%) with a few percentage with rectal bladder (2.2%). Only 7.9% of patients received neoadjuvant chemotherapy. Intra-operative complications were recognized in only 5.3% of patients. 64% of patients experienced one or more of post-operative complications within 90 day of surgery with the most common complication categories were sexual dysfunction (73.46%), genito-urinary (52.19%), gastro intestinal (48.25%), wound-related (41.25%), general (30%), lymphadenectomy-related (21%), pulmonary (6%) and psychological complications (2.6%). Conclusion: Radical Cystectomy is a complex operation and has avoidable post-operative Morbidity and mortality. Various technical improvements of the surgical and anesthesia techniques, multi-disciplinary approach for correction/control of comorbidities and early postoperative rehabilitation have produced salutary effect in reducing the mortality.

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Section: Discussionmentioning

confidence: 94%

Short Term Complications post Radical Cystectomy South Egypt Cancer Institute: 5 years’ experience

2021

SECI Oncology Journal

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“…24,25 Postoperative factors consist of infection and postrenal obstruction. 12,13,22,23,26 Derived from this insight, the following intraoperative strategies have been proposed: a restrictive-deferred hydration strategy avoiding episodes of intraoperative hypotension while maintaining sufficient perfusion pressure by using continuous noradrenaline infusion instead of excessive fluid administration. 15,25,27 The time between induction of anesthesia and surgical incision warrants special attention as a relevant share of hypotensive events occur during this period.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative factors are prolonged time of surgery (>400 min), significant blood loss, episodes of hypotension, and surgical complications 24,25 . Postoperative factors consist of infection and postrenal obstruction 12,13,22,23,26 . Derived from this insight, the following intraoperative strategies have been proposed: a restrictive‐deferred hydration strategy avoiding episodes of intraoperative hypotension while maintaining sufficient perfusion pressure by using continuous noradrenaline infusion instead of excessive fluid administration 15,25,27 .…”

Section: Discussionmentioning

confidence: 99%

Impact of early postoperative creatinine increase on mid‐term renal function after cystectomy

et al. 2022

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Objectives: To determine whether early acute kidney injury affects mid-term renal function, to identify risk factors for impaired mid-term renal function, and to highlight the evolution of plasma creatinine and estimated glomerular filtration rate in the first 12 months after cystectomy and urinary diversion. Methods: We conducted a single-center retrospective observational cohort study from 2000 to 2019. We included 900 consecutive patients undergoing cystectomy and urinary diversion. Patients with incomplete data and preoperative hemodialysis were excluded. Early acute kidney injury was defined as an increase in plasma creatinine of >50% or >26.5 lmol/L within 24 h after surgery. Multiple linear regression analysis was performed to model the association between risk factors and change in plasma creatinine and estimated glomerular filtration rate at 12 months. Results: Early acute kidney injury was diagnosed in 183/900 patients (20.3%) and was associated with significant mid-term plasma creatinine increase compared to preoperative value (+10.0 lmol/L [95% confidence interval À1.5, 25.0] vs +4.0 lmol/L [À7.0, 13.0]; P < 0.001). Similarly, a significant estimated glomerular filtration rate change was found (À11.2 mL/min [95% confidence interval À19.8, 0.6] vs À4.9 mL/min [À15.6, 5.3]; P < 0.001).In the linear regression model, early acute kidney injury increased creatinine at 12 months by 9.8% (estimated glomerular filtration rate: decrease by 6.2 mL/min), male sex by 12.0%. Limitations include retrospective analysis from prospectively assessed data. Conclusions: Early acute kidney injury resulted in elevated plasma creatinine and decreased estimated glomerular filtration rate values 12 months postoperatively, albeit the clinical relevance remains questionable.

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“…Acute kidney injury (AKI) is recognized as a severe complication of advanced cirrhosis, and is similarly known to be a common complication amongst patients undergoing major abdominal surgery, including radical cystectomy [93][94][95]. Hepatorenal syndrome (HRS) in particular, which falls under the larger umbrella of etiologies contributing to AKI, results from decreased renal blood flow in patients with advanced cirrhosis.…”

Section: Hepatorenal Syndromementioning

confidence: 99%

Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations

et al. 2021

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The incidence of liver cirrhosis is increasing worldwide. Patients with cirrhosis are generally at a higher risk of harbouring hepatic and non-hepatic malignancies, including bladder cancer, likely due to the presence of related risk factors such as smoking. Cirrhosis can complicate both the operative and non-surgical management of bladder cancer. For example, cirrhotic patients undergoing abdominal surgery generally demonstrate worse postoperative outcomes, and chemotherapy in patients with cirrhosis often requires dose reduction due to its direct hepatotoxic effects and reduced hepatic clearance. Multiple other considerations in the peri-operative management for cirrhosis patients with muscle-invasive bladder cancer must be taken into account to optimize outcomes in these patients. Unfortunately, the current literature specifically related to the treatment of cirrhotic bladder cancer patients remains sparse. We aim to review the literature on treatment considerations for this patient population with respect to perioperative, surgical, and adjuvant management.

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Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

Cited by 7 publications

References 32 publications

Short Term Complications post Radical Cystectomy South Egypt Cancer Institute: 5 years’ experience

Short Term Complications post Radical Cystectomy South Egypt Cancer Institute: 5 years’ experience

Impact of early postoperative creatinine increase on mid‐term renal function after cystectomy

Muscle-Invasive Bladder Cancer in Patients with Liver Cirrhosis: A Review of Pertinent Considerations

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