Voiding and renal functions ten years after radical cystectomy and orthotopic neobladder in females.

OBJECTIVES: To assess long-term voiding and renal function (RF) changes after radical cystectomy (RC) and orthotopic neobladder (ONB) in females without disease recurrence.

MATERIAL AND METHODS: Female patients who underwent RC and ONB from 1995 and 2011 were included. Patients who developed disease failure or lost follow-up were excluded. The study outcomes were long-term voiding function and the incidence and predictors of RF deterioration (defined by > 20% decline of baseline). Analysis was performed using the log-rank test and Cox regression analysis.

RESULTS: The study included 195 patients with a median (IQR) follow-up of 98 (53-151) months of whom 95 had > 10 years of follow-up. Daytime, night-time continence, and chronic urine retention (CUR) were identified in 170 (87%), 134 (69%) and 52 (27%) patients, respectively. Among patients with >10 years of follow-up, 82 (86%), 66 (70%), and 31 (33%) had daytime, night-time continence, and CUR at the last follow-up visit, respectively. Renal function deterioration events occurred in 74 patients through the follow-up and CKD stage III-V developed in 80 patients. Patients' age [HR (95%CI): 1.41 (1.06-1.89), p=0.02], and serous-lined extramural tunnel (SLET) diversion [HR (95%CI): 0.43 (0.19-0.86), p=0.02] were the independent predictors of RF deterioration. Among patients with >10 years of follow-up, RF deteriorated in 46 (49%) patients and CKD stage III-V developed in 40 (42%).

CONCLUSION: Females surviving more than 10 years after RC and ONB had maintained acceptable continence status apart from a higher CUR rate compared to those followed for < 10 years. Yet, renal function deterioration developed in nearly half of them.