Laparoscopic radical cystectomy: neobladder or ileal conduit, debate still goes on

Abstract

ObjectiveTo compare the pre, intra, and post–operative data between ileal conduit and neobladder urinary diversions during laparoscopic radical cystectomy(LRC).Material and methodsBetween 2006 and 2011, 63 patients who underwent LRC and urinary diversion had their data input prospectively into a database and said data used for the analysis. The outcome comparators were the patient demographics, operative time, conversion rate, blood loss, transfusion rate, morphine analgesic requirement, length of hospital stay, complication rates, follow up, and quality of life assessments. A Mantel–Haenszel test was used for dichotomous data and an inverse variance method was used for continuous data. P values less than 0.5 were considered significantResultsThirty–nine patients (60 ±7.11 years) had ileal conduits and 24 patients (57 ±8.68 years) had neobladder urinary diversion. No difference was found (P >0.05) regarding age, BMI, smoking history, TURBT pathology result, blood loss, blood transfusion requirement, conversion rates, length of hospital stay, morphine requirement, complications, or follow–up and quality of life. The neobladder groups did have more previous abdominal operations and had significantly longer operative time.ConclusionsWe found no difference between either types of diversion in all comparative aspects except that the neobladder had longer operative times. This is the first comparative study between ileal conduit and neobladder urinary diversion after laparoscopic radical cystectomy and can pose as a bench mark for future comparisons.

Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

“…Of the potentially eligible studies, six were excluded, as they were not RCTs; one study was a protocol for an on-going study. Aboumarzouk et al [ 31 ] compared 155 patients undergoing LRC or ORC retrospectively. Aboumohamed et al [ 30 ] reported retrospective data from patients undergoing radical cystectomy.…”

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

“…However it is worth bearing in mind that each type of urinary diversion has inherently different challenges associated with it. 6 According to meta-analysis there is a higher rate of UTI in the orthotopic neobladder group, potentially as orthotopic neobladders often require self-catheterisation which comes with the associated risk of bacterial inoculation. 35 Meta-analysis also demonstrated a significantly higher risk of ureteroileal stricture in patients with an orthotopic neobladder than those with an ileal conduit urinary diversion, possibly due to the use of an anti-reflux mechanism in ureterointestinal anastomosis, however an antireflux mechanism was only used for ONB in two of the publications included in this review.…”