Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function
Background: Augmentation uretero-enterocystoplasty (AUEC) provides a low-pressure urinary storage capsule that can preserve renal function in patients with lower urinary tract dysfunction for whom conservative treatments have failed. Objective: To summarize the effectiveness and safety of augmentati...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | European Urology Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168323001271 |
| _version_ | 1797836907301830656 |
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| author | Xuesheng Wang Zhonghan Zhou Fan Zhang Xing Li Limin Liao |
| author_facet | Xuesheng Wang Zhonghan Zhou Fan Zhang Xing Li Limin Liao |
| author_sort | Xuesheng Wang |
| collection | DOAJ |
| description | Background: Augmentation uretero-enterocystoplasty (AUEC) provides a low-pressure urinary storage capsule that can preserve renal function in patients with lower urinary tract dysfunction for whom conservative treatments have failed. Objective: To summarize the effectiveness and safety of augmentation uretero-enterocystoplasty (AUEC) and evaluate whether it aggravates renal function deterioration in patients with renal insufficiency. Design, setting, and participants: This was a retrospective cohort study of patients who underwent AUEC from 2006 to 2021. Patients were grouped according to whether they had normal renal function (NRF) or renal dysfunction (serum creatinine >1.5 mg/dl). Outcome measurements and statistical analysis: Follow-up of upper and lower urinary tract function was assessed via review of clinical records, urodynamic data, and laboratory results. Results and limitations: We included 156 patients in the NRF group and 68 in the renal dysfunction group. We confirmed that urodynamic parameters and upper urinary tract dilation were significantly improved for patients after AUEC. Serum creatinine declined during the first 10 mo in both groups and remained stable thereafter. The reduction in serum creatine was significantly greater in the renal dysfunction group than in the NRF group in the first 10 mo (difference in reduction 4.19 units; p < 0.05). A multivariable regression model showed that baseline renal dysfunction was not a significant risk factor for deterioration of renal function in patients who had undergone AUEC (odds ratio 2.15; p = 0.11). The main limitations are selection bias because of the retrospective design, loss to follow-up, and missing data. Conclusions: AUEC is a safe and effective procedure to protect the upper urinary tract and will not hasten deterioration of renal function in patients with lower urinary tract dysfunction. In addition, AUEC improved and stabilized residual renal function in patients with renal insufficiency, which is important in preparation for renal transplantation. Patient summary: Bladder dysfunction is usually treated with medication or Botox injections. If these treatments fail, surgery to increase the bladder size using a portion of the patient’s intestine is a possible option. Our study shows that this procedure was safe and feasible and improved bladder function. It did not lead to a further decrease in function in patients who already had impaired kidney function. |
| first_indexed | 2024-04-09T15:16:26Z |
| format | Article |
| id | doaj.art-ba67872d32684cb7b392f9ad8925ee1a |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-04-09T15:16:26Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-ba67872d32684cb7b392f9ad8925ee1a2023-04-29T14:58:32ZengElsevierEuropean Urology Open Science2666-16832023-05-01516269Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal FunctionXuesheng Wang0Zhonghan Zhou1Fan Zhang2Xing Li3Limin Liao4Department of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, Beijing, China; University of Health and Rehabilitation Sciences, Qingdao, ChinaUniversity of Health and Rehabilitation Sciences, Qingdao, China; Cheeloo College of Medicine, Shandong University, Jinan, ChinaDepartment of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, Beijing, ChinaDepartment of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, Beijing, ChinaDepartment of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, Beijing, China; University of Health and Rehabilitation Sciences, Qingdao, China; Cheeloo College of Medicine, Shandong University, Jinan, China; China Rehabilitation Science Institute, Beijing, China; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China; Corresponding author. Department of Urology, China Rehabilitation Research Center, School of Rehabilitation of Capital Medical University, 10 Jiaomen Beilu, Fengtai, Beijing 100068, China. Tel. +86 10 87569043; Fax: +86 10 67570492.Background: Augmentation uretero-enterocystoplasty (AUEC) provides a low-pressure urinary storage capsule that can preserve renal function in patients with lower urinary tract dysfunction for whom conservative treatments have failed. Objective: To summarize the effectiveness and safety of augmentation uretero-enterocystoplasty (AUEC) and evaluate whether it aggravates renal function deterioration in patients with renal insufficiency. Design, setting, and participants: This was a retrospective cohort study of patients who underwent AUEC from 2006 to 2021. Patients were grouped according to whether they had normal renal function (NRF) or renal dysfunction (serum creatinine >1.5 mg/dl). Outcome measurements and statistical analysis: Follow-up of upper and lower urinary tract function was assessed via review of clinical records, urodynamic data, and laboratory results. Results and limitations: We included 156 patients in the NRF group and 68 in the renal dysfunction group. We confirmed that urodynamic parameters and upper urinary tract dilation were significantly improved for patients after AUEC. Serum creatinine declined during the first 10 mo in both groups and remained stable thereafter. The reduction in serum creatine was significantly greater in the renal dysfunction group than in the NRF group in the first 10 mo (difference in reduction 4.19 units; p < 0.05). A multivariable regression model showed that baseline renal dysfunction was not a significant risk factor for deterioration of renal function in patients who had undergone AUEC (odds ratio 2.15; p = 0.11). The main limitations are selection bias because of the retrospective design, loss to follow-up, and missing data. Conclusions: AUEC is a safe and effective procedure to protect the upper urinary tract and will not hasten deterioration of renal function in patients with lower urinary tract dysfunction. In addition, AUEC improved and stabilized residual renal function in patients with renal insufficiency, which is important in preparation for renal transplantation. Patient summary: Bladder dysfunction is usually treated with medication or Botox injections. If these treatments fail, surgery to increase the bladder size using a portion of the patient’s intestine is a possible option. Our study shows that this procedure was safe and feasible and improved bladder function. It did not lead to a further decrease in function in patients who already had impaired kidney function.http://www.sciencedirect.com/science/article/pii/S2666168323001271Augmentation uretero-enterocystoplastyLower urinary tract reconstructionRenal functionUpper urinary tract dilationEffective procedure |
| spellingShingle | Xuesheng Wang Zhonghan Zhou Fan Zhang Xing Li Limin Liao Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function European Urology Open Science Augmentation uretero-enterocystoplasty Lower urinary tract reconstruction Renal function Upper urinary tract dilation Effective procedure |
| title | Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function |
| title_full | Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function |
| title_fullStr | Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function |
| title_full_unstemmed | Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function |
| title_short | Augmentation Uretero-enterocystoplasty Is an Effective Procedure in Protecting the Upper Urinary Tract Without Accelerating Deterioration of Renal Function |
| title_sort | augmentation uretero enterocystoplasty is an effective procedure in protecting the upper urinary tract without accelerating deterioration of renal function |
| topic | Augmentation uretero-enterocystoplasty Lower urinary tract reconstruction Renal function Upper urinary tract dilation Effective procedure |
| url | http://www.sciencedirect.com/science/article/pii/S2666168323001271 |
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