A systematic review and meta-analysis of the long-term outcomes of ileal conduit and orthotopic neobladder urinary diversion

Abstract

Introduction: We aimed to perform a systematic review and meta-analysis on the long-term durability, incidence of complications, and patient satisfaction outcomes in ileal conduit (IC) and orthotopic neobladder (ONB).
 Methods: A systematic electronic literature search was performed in Medline, Embase, Cochrane Library, and Scopus using MeSH and free-text search terms “Urinary diversion” AND “Ileal conduit” AND “Neobladder.” The search concluded June 19, 2018. Inclusion criteria were those patients who had a cystectomy and required urinary diversion by either IC or neobladder.
 Results: In total, 32 publications met the inclusion criteria. Data were available on 46 787 patients (n=36 719 for IC and n=10 068 for ONB). Meta-analyses showed that IC urinary diversions performed less favorably than ONB in terms of re-operation rates, Clavien-Dindo complications, and mortality rates; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.76 (1.24, 2.50) p<0.01, 1.16 (1.09, 1.22) p<0.01, and 6.29 (5.30, 7.48) p<0.01, respectively. IC urinary diversion performed better than ONB in relation to urinary tract infection rates and ureteric stricture rates, OR and 95% CI 0.67 (0.58, 0.77) p<0.01 and 0.70 (0.55, 0.89) p<0.01, respectively.
 Conclusions: Our results show that there is no significantly increased morbidity with ONB compared to IC. Selection of either urinary diversion technique should be based on factors such as tumor stage, comorbidities, surgical experience, and patient acceptance of postoperative sequalae.

Robot-assisted cystectomy with orthotopic vesicoplasty for bladder cancer.

“…При проведении анализа по подгруппам выявлено, что осложнений 1-2 степени по Clavien-Dindo чаще встречались в группе ортотопического необладдера, а осложнения 3-5 степени -в группе с формированием кондуита из сегмента подвздошной кишки. Смертность также была выше в группе с формированием необладдера из сегмента подвздошной кишки и составила 9,6% против 1,6% в группе ортотопического необладдера (ОШ 6,29, 95% ДИ 5,30; 7,48, р<0,01) [69]. Следует отметить, что данный метаанализ имеет ряд ограничений, которые необходимо принимать во внимание при интерпретации результатов: включение в анализ как ретроспективных, так и проспективных исследований случай-контроль, относительно небольшие размеры выборки.…”

Urinary diversions for radical cystectomy: a review of complications and their management

“…Regarding the role of staples in stone formation, Muto et al [19] reviewed their series of stapled neobladders and report a global stone rate of 4.6%, with a risk of stone formation of 4.5%, 6.5%, 8.5%, and 10% at 5, 10, 15, and 20 years, respectively. They highlight the role of synchronous risk factors such as outlet obstruction and UTI in these patients and note that when they treated the stones endoscopically, the stapled lines were usually completely covered by mucosa [19] .…”

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

“…For example, Tellini et al highlighted smoking as a risk factor in a recent meta-analysis, showing a 34% increase in postoperative infections in the pooled estimate [9 ▪▪ ]. Other reported risk factors for infectious complications include increasing age [10], reduced renal function [6], and continent UD such as orthotopic neobladder (ONB) [11].…”