1133 RENAL FUNCTION EVALUATION AFTER ORTHOTOPIC ILEAL NEOBLADDER WITH EXTRAMURAL SEROUS-LINED URETERAL REIMPLANTATION: CHRONIC KIDNEY DISEASE EPIDEMIOLOGY COLLABORATION VERSUS MODIFICATION OF DIET IN RENAL DISEASE EQUATIONS

Vol. 185, No. 4S, Supplement, Monday, May 16, 2011

THE JOURNAL OF UROLOGY姞

suggests that other bioamine(s) that acts as relaxant or contractor in affecting human CC relaxation might be responsible for diabetes related erectile dysfunction. Source of Funding: None

Urinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion Moderated Poster 36 Monday, May 16, 2011

1:00 PM-3:00 PM

1132 ORTHOTOPIC URINARY DIVERSION IN MALE PATIENTS WITH PT4A BLADDER CANCER Hooman Djaladat*, Anirban P. Mitra, Gus Miranda, Eila C. Skinner, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Presence of transitional cell carcinoma in the prostatic stroma is associated with increased risk of urethral recurrence and mortality. Patients with T4a bladder cancer are generally not considered good candidates for orthotopic neobladder (ON) diversion and are typically offered neoadjuvant chemotherapy if known pre-operatively. We evaluated urethral and local recurrence, and oncologic outcomes in male patients with pT4a bladder cancer who underwent heterotopic vs. orthotopic urinary diversion following radical cystectomy. METHODS: 1,964 bladder cancer patients who underwent radical cystectomy at University of Southern California between 1971 and 2008 were analyzed retrospectively. Male patients who had pT4a disease at cystectomy were included. Patients with 30 day perioperative mortality were excluded. Univariate and log rank statistics were used to examine associations between variables and outcome. RESULTS: 156 (7.9%) patients met the inclusion criteria (table 1). Only 45 (28.8%) of these patients were diagnosed with clinical T4a disease prior to cystectomy. Median follow up was 2.7 yrs (range, 0.1–23.6 yrs) during which 118 (75.6%) patients died. There was no difference in 3-yr recurrence free survival between orthotopic and heterotopic diversion (31⫾7% and 38⫾7% respectively). This held true even after stratifying by nodal stage (p⫽0.81) and administration of adjuvant chemotherapy (p⫽0.66). No significant difference in recurrence course or location was noted between diversion types (log rank p⫽0.63). There was also no significant difference in overall survival between diversion types univariately (p⫽0.79), and after multivariate stratification. CONCLUSIONS: Outcomes of patients with pT4a bladder cancer do not differ significantly depending on type of urinary diversion. Orthotopic diversion in pT4a patients was not associated with increased local or urethral recurrence risk. In this subgroup of patients, ON may therefore be a feasible alternative with comparable oncologic outcomes and potentially better quality of life.

Source of Funding: None

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1133 RENAL FUNCTION EVALUATION AFTER ORTHOTOPIC ILEAL NEOBLADDER WITH EXTRAMURAL SEROUS-LINED URETERAL REIMPLANTATION: CHRONIC KIDNEY DISEASE EPIDEMIOLOGY COLLABORATION VERSUS MODIFICATION OF DIET IN RENAL DISEASE EQUATIONS Ahmed M. Mansour*, Hassan Abol-Enein, Ahmed Mosbah, Mohamed A. Ghoneim, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: A recently developed equation, the Chronic Kidney Disease Epidemiology Collaboration, has been proposed to replace the Modification of Diet in Renal Disease for estimated glomerular filtration rate due to higher accuracy. The purpose of this study is to report renal function in patients who underwent orthotopic ileal neobladder with extramural serous-lined ureteral reimplantation with minimal 10 years of follow up comparing the two equations. METHODS: Between January 1992 and June 1998, 311 consecutive patients underwent an ileal w neobladder orthotopic urinary diversion with extramural serous-lined uretero-ileal anastomosis. Utilizing our prospectively maintained database, patients who were living free of malignancy and completed 10 years of follow up were identified (113 Patients). The end points evaluated were pre-operative estimated glomerular filtration rate, last followup estimated glomerular filtration rate (after at least 10 years), absolute and percent change estimated glomerular filtration rate ([absolute change/baseline] ⫻ 100%), and proportion of newly developed chronic kidney disease stage III. RESULTS: Mean follow up was 12.09⫾1.9 years(range: 10.02–15.96). Mean pre-operative estimated glomerular filtration rate derived from the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations were 72 and 79 ml/minute/1.73 m2, respectively, after minimal 10 years follow up were 62 and 69 ml/minute/1.73 m2, respectively. Mean percent change estimated glomerular filtration rate was 13 % and 15 % respectively. The proportion of patients with newly developed chronic kidney disease stage III after minimal 10 years of follow up was 32% and 29%, according to the Modification of Diet in Renal Disease and Chronic Kidney Disease Epidemiology Collaboration equations, respectively. CONCLUSIONS: After more than 10 years of follow up, renal function is preserved in patients who undergo orthotopic ileal neobladder with extramural serous-lined ureteral reimplantation technique. Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations provide comparable results. Around 30% of patients are categorized as having stage III renal disease after 10 years of urinary diversion. Source of Funding: None

1134 RENAL FUNCTION FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER Manuel Eisenberg*, Katherine Cotter, Philip Kim, Jie Cai, Anne Schuckman, Eila Skinner, Siamak Daneshmand, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Radical cystectomy (RC) with orthotopic neobladder (ON) diversion may adversely affect renal function; however, long term effects are not well described. We investigate the natural history of renal function after RC with ON diversion using several estimations of renal function. METHODS: Since 2002, 530 patients were accrued in an IRB approved prospective study evaluating outcomes after RC with ON diversion. Patient demographics, pre- and postoperative laboratory values, chemotherapy and hydronephrosis status were evaluated. Renal function calculated using the 4 variable Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault (CG) equations as well serum bicarbonate (HCO3) levels were analyzed pre-operatively, at discharge, and at 6 months, 1 year, 2 years, and 3 years post-surgery.