首页膀胱肿瘤治疗及预后证据详情

Is Anti-Reflux Anastomosis an Advantage in an Orthotopic Ileal Neobladder? A Systematic Review and Meta-Analysis

原文: 2023 年 发布于 Urol Int 75 卷 第 5 期 825-845 浏览量:189次

作者: Zhang Y. Ding H. Zhang Y. Tian J. Yang L. Dong Z. Wang J. Wang Y. Zhang Y. Wang Z.

作者单位: Key Laboratory of Dependable Service Computing in Cyber Physical Society, Ministry of Education, College of Computer Science, Chongqing University, Chongqing, China. Unit for Laboratory Animal Medicine, Department of Microbiology and Immunology, Center for Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, United States of America. College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan, United States of America.

归属分类: 膀胱肿瘤治疗及预后证据

DOI: 10.2147/ott.s167853

关键词: Humans *Obturator Nerve/physiology/surgery Network Meta-Analysis Transurethral Resection of Bladder *Urinary Bladder Neoplasms/surgery/pathology Reflex bladder cancer lumbar anesthesia obturator nerve block transurethral resection of bladder tumor conflicts of interest to declare.

文献简介

INTRODUCTION: We conducted a systematic review and meta-analysis to assess the available literature regarding the postoperative effects of anti-reflux anastomosis and direct anastomosis in orthotopic ileal neobladder (ONB). METHODS: We searched PubMed, Embase, and the Cochrane Library in October 2021. We included 11 studies of patients with bladder cancer who underwent radical cystectomy and ONB as urinary diversion. Outcomes evaluated in this review were ureteroenteric anastomotic stricture (UEAS), vesicoureteral reflux, renal function (RFn) impairment, and pyelonephritis. All data were analyzed using Review Manager 5.4.4 and subgroup analyses were applied. RESULTS: A total of 11 studies were eligible for meta-analysis. The synthetic data suggested that anti-reflux anastomosis and direct anastomosis were comparable in terms of RFn impairment (odds ratio (OR) = 1.69; 95% confidence interval (CI): 0.18-15.6; p = 0.65, I2 = 69%) and pyelonephritis (OR = 1.13; 95% CI: 0.65-1.99; p = 0.66, I2 = 1%) without significant difference in each group statistically. The pooled study data showed a significantly higher incidence of UEAS (OR = 2.84; 95% CI: 1.75-4.61, p < 0.0001, I2 = 50%) and a lower incidence of vesicoureteral reflux (OR = 0.24; 95% CI: 0.10-0.59; p = 0.002, I2 = 75%) in anti-reflux anastomosis compared to direct anastomosis. In subgroup analysis, anti-reflux anastomosis was more likely to result in UEAS than direct anastomosis, especially when ureteral stent was removed within 14 days. CONCLUSION: Although meta-analysis showed that overall incidence of vesicoureteral reflux was higher with direct anastomosis than anti-reflux anastomosis, the rate of vesicoureteral reflux was not directly related to impairment of RFn. The anti-reflux mechanism of ONB was positively associated with a higher incidence of significant UEAS compared to the direct approach, which can lead to kidney damage and an increased risk of secondary surgical procedures.

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