Upper Urinary System Changes After Radical Cystectomy and Bricker Urinary Diversion: A Retrospective Evaluation of Functional and Radiological Parameters.

Background/

Objectives

Our objective is to evaluate the long-term effects of radical cystectomy and Bricker ileal conduit urinary diversion on upper urinary tract function and structure, with a specific focus on radiological and laboratory changes in renal function.

Methods

A retrospective analysis was conducted of 120 patients who underwent radical cystectomy (RC) and Bricker ileal conduit urinary diversion between 2010 and 2024. Clinical, laboratory, and radiological data were assessed over a 24-month follow-up period. Renal parenchymal thickness, kidney volumes, and hydronephrosis grades were analyzed, and the relationship between interventions and renal outcomes was examined.

Results

Postoperative follow-up showed a progressive decrease in renal parenchymal thickness and kidney volume, particularly in the left kidney. Hydronephrosis occurred in both renal units, with higher rates on the left side. Despite these changes, only a subset of patients required intervention, typically due to sepsis, acute renal failure, or pain. No significant deterioration in median estimated glomerular filtration rate values was observed; however, patients with interventions showed higher anteroposterior diameter/parenchymal thickness ratios, suggesting increased parenchymal damage.

Conclusions

Following radical cystectomy and Bricker ileal conduit diversion, mild to moderate hydronephrosis is not uncommon and does not always necessitate intervention, especially in patients without clinical symptoms. Radiological parameters like renal parenchymal thickness and kidney volume may be valuable for monitoring renal deterioration. Careful follow-up and selective intervention are crucial in preserving renal function in this patient group.