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Long-term renal function in patients undergoing surgical reconstruction for tubercular cicatrized bladder

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Abstract

Purpose

We evaluated the long-term renal function in patients after surgical reconstruction for tuberculous contracted bladder (TBC) and determined factors associated with decreased renal function (RF) during follow up.

Materials and methods

We reviewed the records of 61 patients who underwent augmentation cystoplasty (AC) or orthotopic neobladder (ONB) for TBC between June 1994 and August 2019 in our institute. The estimated glomerular filtration rate (eGFR) was calculated preoperatively at initial presentation, before augmentation and at various intervals during follow up. Renal function decrease was defined as a defined as new-onset stage-3A Chronic kidney disease(CKD) or upstaging of pre-operative CKD stage 3A in follow-up. Multivariable analysis was done to evaluate the association of clinicopathological features and postoperative complications with decreased renal function.

Results

We analyzed 39 patients who had a minimum follow-up of 1-year post reconstruction. At a median follow-up of 52 months (IQR 31–103 months), 16/39 patients developed RF decrease. In univariate analyses, initial eGFR, and associated ureteric stricture in contralateral renal unit were significantly associated with new-onset renal insufficiency (p < 0.001 each). On multivariable analysis, only initial presenting eGFR (p < 0.001) was an independent predictor of new-onset renal insufficiency. ROC cut-off levels for eGFR at presentation predicting the primary end point of RF decrease was 45 ml/min.

Conclusions

Decreased renal function is noted in most patients during long term follow-up after surgical reconstruction for TBC. After controlling for preoperative and postoperative risk factors, patients with initial presenting GFR < 45 ml/min are at greater risk of a decline in renal function following reconstruction.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, 515134, India

    P. Ashwin Shekar, Hardik Patel, Dinesh Reddy & Anuj Dumra

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  1. P. Ashwin Shekar
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  2. Hardik Patel
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  3. Dinesh Reddy
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  4. Anuj Dumra
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Contributions

ASP and HK contributed to the design and implementation of the research, AD and DR to the analysis of the results and to the writing of the manuscript. ASP conceived the original and supervised the project.

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Correspondence to P. Ashwin Shekar.

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Shekar, P.A., Patel, H., Reddy, D. et al. Long-term renal function in patients undergoing surgical reconstruction for tubercular cicatrized bladder. World J Urol 41, 1681–1689 (2023). https://doi.org/10.1007/s00345-023-04384-1

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  • DOI: https://doi.org/10.1007/s00345-023-04384-1

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