Renal functional changes after radical cystectomy in the early-mid term period

INTRODUCTION: To evaluate the postoperative early-mid term renal functions of patients who underwent open radical cystectomy for bladder tumor.
METHODS: In the study, demographic, operative, postoperative data and postoperative 1st day, 1st, 3rd, 6th, 9th and 12th month renal function values of 76 patients who underwent open radical cystectomy due to bladder tumor between December 2010 and October 2019 were evaluated. Patients who underwent concomitant nephrectomy, history of dialysis due to preoperative chronic renal failure, history of solitary kidney and had a follow-up less than 1 year were excluded from the study.
RESULTS: A total of 51 patients were included in the study. The mean age of the patients was 64.31 ± 8.37years. Ileal conduit was applied to 86.3% of the patients, while orthotopic bladder was applied to 13.7%. While postoperative renal functions decreased in 51% of the patients, it was found that there was an increase or no change in 49% of the patients. While preoperative eGFR was 62.70 ± 23.22 mL / min / 1.73 m2, postoperative 1-3 days, 1st month, 3rd month, 6th month, 9th month, and 12th month eGFR values were 58.55 ± 28.08, 64.67 ± 26.52, 64.35 ± 23.23, 61.18 ± 24.80, 59.93 ± 21.99 and 58.09 ± 22.33 mL / min / 1.73 m2, respectively. While the eGFR levels relatively rapid decrease in the early perioperative period, but a gradual change was observed afterward for the periodic eGFR measurements performed within 1 year after the procedure.
DISCUSSION AND CONCLUSION: The rapid deterioration in renal functions can be observed in the early period in muscle-invasive or high-risk bladder tumors after the open radical cystectomy, but it seems to approach normal values with close follow-up. In this procedure with high morbidity and mortality, we recommend close follow-up and care, especially in the early postoperative period, in order to protect renal functions.

Radikal sistektomi sonrasý erken-orta dönem renal fonksiyonel deðiþiklikler

GÝRÝÞ ve AMAÇ: Mesane tümörü nedeniyle açýk radikal sistektomi uygulanan hastalarýn postoperatif kýsa-orta dönemdeki renal fonksiyonlarýndaki deðiþimlerinin deðerlendirilmesi.
YÖNTEM ve GEREÇLER: Çalýþmada Aralýk 2010-Ekim 2019 tarihleri arasýnda mesane tümörü nedeniyle açýk radikal sistektomi uygulanan toplam 76 hastanýn, demografik, operatif ve postoperative verileri ile postoperative 1. gün, 1., 3., 6., 9. ve 12. ay renal fonksiyon deðerlerinin iþlem öncesine göre deðiþimleri deðerlendirildi. Eþ zamanlý nefrektomi uygulanan, preoperatif kronik böbrek yetmezliði nedeniyle diyaliz öyküsü bulunan, tek böbrekli olan ve 1 yýldan daha az takipli hastalar çalýþmaya dahil edilmedi.
BULGULAR: Çalýþmaya toplam 51 hasta dahil edildi. Hastalarýn yaþ ortalamasý 64,31± 8,37 yýl idi. Hastalarýn % 86.3’üne ileal konduit uygulanýrken, %13.7 sine ortotopik mesane uygulandý. Postoperatif renal fonksiyonlar hastalarýn %51 sinde düþüþ gösterirken, %49 ýnda artýþ izlendiði ya da deðiþim izlenmediði tesbit edildi. Preoperatif eGFR 62.70± 23.22 mL/min/1.73 m2 iken postoperatif 1-3 gün, 1. ay, 3, ay, 6.ay, 9.ay, 12. ay eGFR deðerleri sýrasýyla 58.55±28.08, 64.67±26.52, 64.35±23.23, 61.18±24.80, 59.93±21.99 ve 58.09± 22.33 mL/min/1.73 m2 þeklinde kaydedildi. Ýþlem sonrasý 1 yýl içinde yapýlan periyodik eGFR ölçümlerinde peroperatif erken dönemde nisbeten hýzlý eGFR düþüþü izlenirken sonrasýnda kademeli bir deðiþim olduðu görüldü.
TARTIÞMA ve SONUÇ: Kas invaziv ve yüksek risk mesane tümörlerinde açýk radikal sistektomi sonrasý erken dönemde renal fonksiyonlarda ani bozulmalar izlenebilirken sonrasýnda yakýn takip izlemle normal deðerlerine yaklaþtýðý görünmektedir. Morbidite ve mortalitesi yüksek bu prosedür de renal fonksiyonlarýn korunmasý açýsýndan özellikle postoperatif erken dönemde yakýn takip ve izlem önermekteyiz.