A Systematic Review and Meta-analysis on Perioperative Stenting/Dwell Time and Postoperative Outcomes in Patients Undergoing Radical Cystectomy and Urinary Diversion for Bladder Cancer.
Mithun Kailavasan, Alberto Martini, Max Bruins, Albert Carrion, Richard Cathomas, Eva Compérat, Jason A Efstathiou, Rainer Fietkau, Anna Lorch, Laura S Mertens, Richard P Meijer, Paramanathan Mariappan, Mathew I Milowsky, Yann Neuzillet, Valeria Panebianco, Michael Rink, George N Thalmann, S Sæbjørnsen, Toine van der Heijden
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Abstract
Background and objective: Ureteral stents are used to protect the ureteroenteric anastomosis during radical cystectomy and urinary diversion (RCUD); however, complications can occur from its use. The objective of this study was to perform a systematic review of perioperative stenting strategies and postoperative outcomes in patients undergoing RCUD for bladder cancer.
Methods: This review was published via PROSPERO (CRD42024558468) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. Prospective comparative (randomised and nonrandomised) studies published until June 2024 were included. All outcomes were included in the analysis. Risk of bias assessments were undertaken.
Key findings and limitations: The search yielded 1516 abstracts. Six prospective comparative studies (740 patients) were included. Although there was some evidence of reduced postoperative complications (urinary leak, ureteroileal stricture, postoperative obstruction, length of stay, and readmission within 30 d) with the omission of stents during RCUD, this did not reach statistical significance (n = 3). No differences in postoperative complications were identified between internal and external stenting (n = 2). Early stent removal (5 d) was associated with reduced urinary tract infections and hospital readmission (n = 1). There was a high/serious risk of bias with all studies.
Conclusions and clinical implications: The role of perioperative stenting during RCUD in preventing ureteroenteric complications remains equivocal and does not favour one approach over another. Until further results from on-going randomised controlled trials become available, urologists should carefully consider the indications to place a ureteric stent and its retention time after RCUD.
期刊介绍：
European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU).
EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.
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