Renal function evaluation in patients undergoing orthotopic bladder substitution: a systematic review of literature

Abstract

Renal function (RFn) after orthotopic bladder substitution (OBS) is a critical point to be assessed. We performed a systematic review of MEDLINE for full length peer reviewed English articles from the year 2000 till January 2013. We included only original articles and excluded reviews, editorials and replies and abstracts presented in conferences. The outcome is formulated in research questions; what is the status of RFn after OBS? Which is better, the direct free-refluxing or anti-refluxing ureteroileal anastomosis (UIA) techniques? Studies reporting RFn as secondary outcome were also reported. A total of 129 publications were reviewed for full text and only 41 were included in this review. All studies were of low level of evidence and grade of recommendations. Only 3 randomized controlled trials were included and were of poor quality. Renal function after OBS was poorly described in the literature with no universal definition about RFn deterioration or outcome with no consensus on the best evaluation method. Urinary obstruction, chemotherapy and pyelonephritis appeared significant factors but with insufficient evidence. There is a universal trend to use the free refluxing technique for UIA to avoid complications of anti-refluxing techniques. However, the anti-reflux technique proved acceptable outcome in experienced hands. There is marked heterogeneity and underestimation of RFn evaluation among reported outcomes after OBS with most publications reporting the incidence of UIA and pyelonephritis with paucity reporting absolute figures about RFn measurements. In conclusion, urinary tract obstruction remains the main factor of RFn deterioration after OBS. Methods evaluating RFn, definitions of RFn outcome and factors predicting it are poorly studied in the literature and the current evidence is relatively weak to draw solid conclusions. Further well-designed studies and consensus about method of assessment and definitions of RFn are warranted.

The Course of Renal Function After Radical Cystectomy with Ileal Conduit Diversion for Bladder Cancer

“…In our study, renal function deterioration was seen in 53.3% of patients in the first year and 41.1% of patients in the fifth year. (1,2,3,24,25,26,27). Although the preoperative and postoperative eGFR values were statistically insignificant, the development of postoperative urinary tract obstruction and postoperative urinary tract infection were the only significant risk factors for renal deterioration.…”

Orthotopic urinary diversions after radical cystectomy for bladder cancer: lessons learned last decade

“…Of these, urinary tract obstruction due to ureteroileal stricture is more common. Performing an antirefluxing ureteroileal anastomosis has long been thought to lead to increased ureteroenteric stricture rates, possibly due to the increased dissection and handling of the ureter during surgery which lends itself to ischemic changes [25]. However, neither the more commonly used free-refluxing method nor the antireflux technique have proven superior to the other.…”

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

“…Conversely, in attempt to homogenize the cohort, we performed a sub-analysis excluding patients underwent nephroureterectomy with cystectomy, in this context, orthotopic substitution came into focus. It has been reported that the link between orthotopic substitution and renal function deterioration was attributed to the development of UIA stricture and to a less extent, pyelonephritis ( 27 ). Recently, there has been a focus on the effect of uri-nary diversion type on renal function.…”