URINARY DIVERSION AFTER RADICAL CYSTECTOMY, ORTHOTOPIC NEOBLADDER VS ILEAL CONDUIT: A SYSTEMATIC REVIEW AND META-ANALYSIS OF POSTOPERATIVE COMPLICATION

Muhammad Fahri, Gampo Alam
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Abstract

ABSTRACT Objective: The purpose of this study is to compare orthotopic neobladder (ONB) and ileal conduit (IC) formation in terms of surgical outcome and complication. Material & Methods: Computerized bibliographic search on different databases related to this study. The PICO criteria method was applied to define research eligibility, per PRISMA recommendations and conducted a systematic review of the literature with meta-analysis. Weighted mean differences with 95 percent confidence intervals were used to compare continuous outcomes. Results: There were 479 publications were discovered and only 6 studies fulfilled the criteria included. The random-effect model's pooled result for urinary leakage complication revealed a significant difference of 1.62 between ONB and IC with higher incidence in neobladder group (95 percent CI, 1.85, 8.69, P = 0.0004) with non-significant heterogeneity (Chi2 = 0.65, df = 3 (P = 0.89), I2 = 0%). Other complications (ileus complication, anastomosis site stenosis, sepsis, urinary infection) showed non-significant difference. Conclusion: Because of the heterogeneity in several aspects of the analyzed papers, further study comparing Orthotopic Neobladder and Ileal conduit in terms of complication following urinary diversion are needed to confirm superiority of ONB or IC as the urinary diversion of choice. Keywords: Orthotopic neobladder, ileal conduit, urinary diversion, radical cystectomy
根治性膀胱切除术后尿改道,原位新膀胱vs回肠导管:术后并发症的系统回顾和荟萃分析
摘要目的:本研究的目的是比较原位新膀胱(ONB)和回肠导管(IC)形成的手术效果和并发症。材料与方法:计算机检索与本研究相关的不同数据库的书目。根据PRISMA的建议,应用PICO标准方法确定研究资格,并对文献进行meta分析的系统评价。采用95%置信区间的加权平均差异来比较连续结果。结果:共发现文献479篇,仅有6篇符合纳入标准。尿漏并发症的随机效应模型汇总结果显示,ONB组与IC组尿漏并发症的发生率差异有统计学意义(1.62,95% CI, 1.85, 8.69, P = 0.0004),但异质性不显著(Chi2 = 0.65, df = 3 (P = 0.89), I2 = 0%)。其他并发症(肠梗阻、吻合口狭窄、脓毒症、尿路感染)差异无统计学意义。结论:由于所分析的文献在多个方面存在异质性,需要进一步研究原位新膀胱与回肠导管在尿改道后并发症的比较,以确定ONB或IC作为尿改道选择的优势。关键词:原位新膀胱,回肠导管,尿分流,根治性膀胱切除术
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