Nabi G, Yong S M, Ong E, McPherson G, Grant A, N'Dow J
Academic Urology Unit, Department of Surgery, School of Medicine, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
J Urol. 2005 Jul;174(1):21-8. doi: 10.1097/01.ju.0000162021.24730.4f.
In this systematic review we determined whether the outcome of orthotopic bladder replacement is superior to that of continent and incontinent urinary diversion.
We searched MEDLINE, PubMed, EMBASE, CINAHL and the Cochrane Library from January 1990 to January 2003. A total of 3,370 abstracts were reviewed, including all types of studies from prospective, randomized, controlled studies to small, retrospective series. All relevant articles with at least 10 patients and a mean followup of at least 1 year were retrieved. There were no language restrictions. NonEnglish articles were translated. Comparisons were made between the major surgery types, including ileal conduit, continent diversion, bladder reconstruction and bladder replacement. All studies were scored using a predetermined quality assessment checklist to assess internal validity (bias and confounding) and external validity.
A total of 405 studies met inclusion criteria. There were 32 prospective and 373 retrospective studies describing a total of 32,795 patients. The majority of studies were incompletely or poorly described and outcomes were often not defined. When they were defined, definitions varied. In clinical outcomes ileal conduit diversions had the lowest operative complications rate but highest reported postoperative morbidity. They also had a higher reported incidence of symptomatic urinary tract infections. The rates of postoperative morbidity, mortality and need for reoperation varied widely among studies even for the same procedure. Of physiological outcomes metabolic acidosis was the most commonly reported metabolic complication in patients with various urinary diversions. The quality of the reported literature was poor. There were no studies of the health economic implications of performing 1 type of surgery vs another type.
While enthusiasts regard orthotopic bladder replacement as the new gold standard when lower urinary tract function must be replaced, the level and quality of current evidence are poor. The immediate concern must be to rectify this paucity of evidence with well designed and well reported prospective studies, ideally in a randomized setting, comparing the various major forms of urinary diversion and bladder replacement surgery.
在本系统评价中，我们确定原位膀胱替代术的结果是否优于可控性和不可控性尿流改道术。
我们检索了1990年1月至2003年1月期间的MEDLINE、PubMed、EMBASE、CINAHL和Cochrane图书馆。共审查了3370篇摘要，包括从前瞻性、随机对照研究到小型回顾性系列的所有类型研究。检索了所有至少有10例患者且平均随访至少1年的相关文章。无语言限制。非英文文章进行了翻译。对主要手术类型进行了比较，包括回肠膀胱术、可控性尿流改道术、膀胱重建术和膀胱替代术。所有研究均使用预先确定的质量评估清单进行评分，以评估内部有效性（偏倚和混杂因素）和外部有效性。
共有405项研究符合纳入标准。有32项前瞻性研究和373项回顾性研究，共描述了32795例患者。大多数研究描述不完整或不佳，结果往往未明确界定。当结果被界定时，定义也各不相同。在临床结果方面，回肠膀胱术的手术并发症发生率最低，但术后发病率报告最高。有症状的尿路感染报告发病率也较高。即使对于相同的手术，术后发病率、死亡率和再次手术需求在不同研究中差异很大。在生理结果方面，代谢性酸中毒是各种尿流改道术患者中最常报告的代谢并发症。报告的文献质量较差。没有关于一种手术类型与另一种手术类型的健康经济影响的研究。
虽然热心者将原位膀胱替代术视为在下尿路功能必须替代时的新金标准，但目前证据的水平和质量较差。当务之急必须是通过精心设计和报告良好的前瞻性研究来纠正这种证据不足的情况，理想情况下是在随机环境中，比较各种主要形式的尿流改道术和膀胱替代手术。
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