A systematic review and meta-analysis of the long-term outcomes of ileal conduit and orthotopic neobladder urinary diversion
AuthorBrowne, E; Lawrentschuk, N; Jack, GS; Davis, NF
Source TitleCanadian Urological Association journal = Journal de l'Association des urologues du Canada
PublisherCANADIAN UROLOGICAL ASSOCIATION
University of Melbourne Author/sLawrentschuk, Nathan
AffiliationSurgery (Austin & Northern Health)
Document TypeJournal Article
CitationsBrowne, E., Lawrentschuk, N., Jack, G. S. & Davis, N. F. (2021). A systematic review and meta-analysis of the long-term outcomes of ileal conduit and orthotopic neobladder urinary diversion. CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL, 15 (1), pp.E48-E57. https://doi.org/10.5489/cuaj.6466.
Access StatusAccess this item via the Open Access location
Open Access URLPublished version
INTRODUCTION: We aimed to perform a systematic review and meta-analysis on the long-term durability, incidence of complications, and patient satisfaction outcomes in ileal conduit (IC) and orthotopic neobladder (ONB). METHODS: A systematic electronic literature search was performed in Medline, Embase, Cochrane Library, and Scopus using MeSH and free-text search terms "Urinary diversion" AND "Ileal conduit" AND "Neobladder." The search concluded June 19, 2018. Inclusion criteria were those patients who had a cystectomy and required urinary diversion by either IC or neobladder. RESULTS: In total, 32 publications met the inclusion criteria. Data were available on 46 787 patients (n=36 719 for IC and n=10 068 for ONB). Meta-analyses showed that IC urinary diversions performed less favorably than ONB in terms of re-operation rates, Clavien-Dindo complications, and mortality rates; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.76 (1.24, 2.50), p<0.01; 1.16 (1.09, 1.22), p<0.01; and 6.29 (5.30, 7.48), p<0.01, respectively. IC urinary diversion performed better than ONB in relation to urinary tract infection rates and ureteric stricture rates, OR and 95% CI 0.67 (0.58, 0.77), p<0.01; and 0.70 (0.55, 0.89), p<0.01, respectively. CONCLUSIONS: Our results show that there is no significantly increased morbidity with ONB compared to IC. Selection of either urinary diversion technique should be based on factors such as tumor stage, comorbidities, surgical experience, and patient acceptance of postoperative sequalae.
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