Urogenital Function and Oncologic Outcomes after Nerve-Sparing Radical Cystectomy: A Systematic Review and Meta-Analysis.

Objective: This systematic review and meta-analysis aimed to determine the impact of nerve-sparing radical cystectomy (NS RC) on genitourinary function and oncologic outcomes in patients with bladder cancer (BCa).

Methods: We conducted a systematic search for literature related to the treatment of BCa with NS RC and non-NS RC in PubMed, Cochrane Library, Web of Science, and China National Knowledge Infrastructure. Two independent researchers screened the literature according to pre-established inclusion and exclusion criteria and had the literature assessed for quality. After extracting data from eligible ones, the research team performed a meta-analysis using Review Manager (RevMan) 5.4.1. They further conducted Begg's test using Stata 17 to assess publication bias.

Results: A total of 261 articles were retrieved. Nine studies met the inclusion criteria, and 740 patients were enrolled in the study. The surgical procedures in the intervention group included prostate capsule sparing cystectomy, prostate-sparing cystectomy, and NS RC. Five studies evaluated urinary incontinence after surgery. After excluding one with a significant source of heterogeneity, the pooled risk ratio (RR) of the four studies was 0.56 (95% confidence interval (CI) (0.35-0.89), p = 0.01). Four studies evaluated erectile dysfunction after surgery. After excluding one with obvious heterogeneity, the pooled RR of the three studies was 0.54 (95% CI (0.36-0.83), p = 0.005). Four studies evaluated the cancer survival rate, and the pooled RR of the four studies was 1.08 (95% CI (0.97-1.21), p = 0.16). Two studies evaluated incisal positive, and the pooled RR of the two studies was 0.83 (95% CI (0.28-2.46), p = 0.74). Four studies evaluated recurrence or metastasis, and the pooled RR of the four studies was 0.54 (95% CI (0.25-1.14), p = 0.10).

Conclusions: NS RC can reduce the risk of urinary incontinence and erectile dysfunction in patients with BCa after surgery, and it has no significant effect on oncologic outcomes.