A 54-year-old man with muscle-invasive bladder cancer underwent cystoprostatectomy and ileal orthotopic neobladder urinary diversion.
Pathology demonstrated pT2N0M0 Stage II disease. His pre-operative estimated glomerular filtration rate (eGFR) is above 60 mL/min per 1.73 m2.
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Ileal neobladder urinary diversion utilizes approximately 60 cm of the small intestine to construct a spherical urinary reservoir that is anastamosed to the ureters and the urethera.
The patient voids by relaxing the muscles of the pelvic floor and performing the Credè maneuver. Long-term data from patients who survived more than 10 years following a neobladder urinary diversion reveal that approximately 20% of patients exhibit renal deterioration as defined by an eGFR drop greater than 10 mL/min per 1.73 m2.
The same large series reveals that over 35% of patients with a standard ileal conduit urinary diversion demonstrate renal function deterioration over 10 years of follow-up.
Meaningful comparisons between the two types of urinary diversions with regard to long-term renal function are difficult, as the clinical profiles of the two patient groups are quite different.
Urinary obstruction at the ureteral, urethral (for neobladder patients), or stomal (for ileal conduit patients), especially when accompanied by infections, is the most common cause of long-term renal deterioration.
Answer: Urinary obstruction
The case was prepared by Alexander Kutikov, MD, FACS, Associate Professor of Urologic Oncology, Fox Chase Cancer Center, Philadelphia.
Jin, XD, Roethlisberger S, Burkhard FC, et al. Long-term renal function after urinary diversion by ileal conduit or orthotopic ileal bladder substitution. Eur Urol 2012;61:491-497.