Oncologic and Renal Function Outcomes After Radical Cystectomy and Ureterocutaneostomy: A Single Center Experience

Objective: It is aimed to present the long-term oncologic and nephrological follow-up results in patients who underwent radical cystectomy and ureterocutaneostomy (RC+UC) due to localized muscle-invasive bladder cancer (MIBC). Materials and Methods: A total of 83 patients diagnosed with localized MIBC (age >= 70 years or an American Society of Anesthesiologists score >= 3), who underwent RC+UC between January 1995 and June 2013, were evaluated retrospectively. Patients who died due to postoperative early surgical complications and patients with a preoperative glomerular filtration rate (GFR) <50 mL/minxm(2)), a solitary kidney, another malignancy, a dialysis history, and patients without a follow-up information record were excluded. Results: The median age of the patients was 71 years. Seventy-three (88%) were male. Distant organ metastasis was detected in 33 patients. Thirty-one (37.3%) patients died of causes other than cancer, 35 (42.2%) died from cancer progression, and 17 (20.5%) survived. Preoperatively, 38 had hydroureteronephrosis (HUN) in one or both kidneys and 6 had undergone preoperative urinary diversion. Sixty-three (75.9%) patients had stoma stenosis, and they were followed with ureteral stents. The number of patients requiring permanent dialysis due to postrenal acute renal failure was 5 (6%). A significant difference was observed between the preoperative, first- and third-year GFR levels in 52 patients having at least a 3-year follow-up period. The change in GFR was found to be 32% after 3 years of follow-up in these patients. The decrease in GFR was more prominent in patients with preoperative HUN. Conclusion: RC+UC should be considered as an option in carefully selected patients in whom the risk of renal function loss is acceptable in terms of age, comorbidity, and life expectancy.