Radical cystectomy with stentless urinary diversion: A systematic review and meta-analysis of comparative studies.

IF 2.4 3区医学 Q3 ONCOLOGY Urologic Oncology-seminars and Original Investigations Pub Date : 2024-08-19 DOI:10.1016/j.urolonc.2024.06.025

Alessandro Veccia, Davide Brusa, Lorenzo Treccani, Sarah Malandra, Emanuele Serafin, Sonia Costantino, Francesco Cianflone, Francesco Ditonno, Francesca Montanaro, Francesca Fumanelli, Matteo Ferro, Giorgio Mazzon, Riccardo Autorino, Riccardo Bertolo, Alessandro Antonelli

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引用次数: 0

Abstract

Purpose: To systematically compare the evidence about surgical outcomes, postoperative complications, and sequelae of Radical cystectomy with urinary diversion with or without stent placement.

Material and methods: A literature search was performed through PubMed, Scopus®, and Web of Science up to December 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The study protocol was registered in PROSPERO (CRD 42023492384), and the research question was formulated according to the PICOs model. Three comparative studies were identified, 2 randomized and 1 prospective coming from a randomized cohort.

Results: The stent group showed higher odds of postoperative major complications (OR 3.00 - 95%CI 1.06; 8.52; P = 0.04) than the stentless group. There was no statistically significant difference between the 2 groups regarding 30-day readmission (P = 0.06), postoperative uretero-ileal anastomotis stricture (UIAS) (P = 0.09), postoperative uretero-ileal anastomotis leak (UIAL) (P = 0.20), postoperative urinary tract infections (UTIs) (P = 0.08), and postoperative ureteral obstruction (P = 0.35). No statistically significant difference between the 2 groups was found regarding UIAS management in terms of ureteral reimplantation (P = 0.28) or dilatation (P = 0.36).

Conclusions: Our pooled data analysis shows no statistically significant difference between stentless and stented urinary diversion after radical cystectomy. Stentless could be a reasonable choice when performing diversion during radical cystectomy.

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根治性膀胱切除术与无支架尿流改道：比较研究的系统回顾和荟萃分析。

目的：系统比较有支架或无支架根治性膀胱切除术的手术效果、术后并发症和后遗症的相关证据：根据《系统综述与元分析首选报告项目》（Preferred Reporting Items for Systematic Review and Meta-analysis，PRISMA）声明，通过 PubMed、Scopus® 和 Web of Science 对截至 2023 年 12 月的文献进行了检索。研究方案已在 PROSPERO（CRD 42023492384）上注册，研究问题根据 PICOs 模型制定。共确定了三项比较研究，其中两项是随机研究，一项是来自随机队列的前瞻性研究：支架组术后出现主要并发症的几率（OR 3.00 - 95%CI 1.06; 8.52; P = 0.04）高于无支架组。两组在 30 天再入院（P = 0.06）、术后输尿管-回肠吻合口狭窄（UIAS）（P = 0.09）、术后输尿管-回肠吻合口漏（UIAL）（P = 0.20）、术后尿路感染（UTI）（P = 0.08）和术后输尿管梗阻（P = 0.35）方面没有统计学差异。在输尿管再植（P = 0.28）或扩张（P = 0.36）方面，两组患者在UIAS处理方面没有统计学差异：我们的汇总数据分析显示，根治性膀胱切除术后，无支架和有支架尿流改道之间没有统计学意义上的显著差异。在根治性膀胱切除术后进行尿流改道时，无支架可能是一个合理的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.