Tao Sha, Long Zhaolin, Zhang Xin-Ji, Chen San-San, Zhu Dajian, Shi Xiao-Jun, Tan Wan-Long
Department of Urology, People's Hosptial of Xuancheng City, Xuancheng, An hui, China.
Department of Urology, Shunde First People's Hospital Affiliated to Southern Medical University, Guangdong, China.
Int J Surg. 2016 Mar;27:39-45. doi: 10.1016/j.ijsu.2016.01.044. Epub 2016 Jan 20.
To evaluate and compare the functional outcomes of ileal and sigmoid neobladders in patients underwent radical cystectomy.
Relevant studies were identified by searching PubMed, Embase, and Cochrane Library. The studies comparing the functional outcomes of sigmoid neobladder (SN) and ileal neobladder (IN) in patients underwent radical cystectomy were included.
A total of 12 cohort studies were included in this meta-analysis. From our analysis, more early complications were observed in SN group than in IN group (RR = 1.37, 95% CI: 1.03-1.81). Both daytime and nighttime continence rates were significantly better in IN group than in SN group (RR = 0.87, 95%CI: 0.81-0.94) (RR = 0.73, 95%CI: 0.60-0.90). More patients could spontaneous voiding in SN group than in IN group (RR = 1.12, 95%CI: 1.00-1.26). According to the urodynamic study, ileal neobladder exhibited bigger capacity (WMD = -84.93, 95%CI: -160.36 to -9.50), lower pressure at capacity (WMD = 11.18, 95%CI: 4.29-18.06), better compliance (WMD = -25.55, 95%CI: -32.45 to -18.64), and greater post-void residual volume(WMD = -23.48, 95%CI: -36.75 to -10.21); There was no significant difference in the max voiding flow rate or void volume between the two groups (WMD = -1.00, 95%CI: -3.73-1.73) (WMD = -27.00, 95%CI: 70.05-16.06). No significant difference was found in the serum creatinine between the two groups (WMD = -0.05, 95%CI: -0.12-0.03).
Ileal neobladder seems able to provide more favorable patient's satisfaction, while sigmoid neobladder may provide a better chance of spontaneous voiding. This meta-analysis may provide some useful evidences for urological surgeons to choose the ideal bladder substitute for patients underwent radical cystectomy.
评估并比较接受根治性膀胱切除术患者的回肠新膀胱和乙状结肠新膀胱的功能结局。
通过检索PubMed、Embase和Cochrane图书馆来识别相关研究。纳入比较接受根治性膀胱切除术患者的乙状结肠新膀胱（SN）和回肠新膀胱（IN）功能结局的研究。
本荟萃分析共纳入12项队列研究。根据我们的分析，SN组比IN组观察到更多早期并发症（RR = 1.37，95%CI：1.03 - 1.81）。IN组的日间和夜间控尿率均显著优于SN组（RR = 0.87，95%CI：0.81 - 0.94）（RR = 0.73，95%CI：0.60 - 0.90）。SN组能自主排尿的患者比IN组更多（RR = 1.12，95%CI：1.00 - 1.26）。根据尿动力学研究，回肠新膀胱容量更大（WMD = -84.93，95%CI：-160.36至-9.50），容量时压力更低（WMD = 11.18，95%CI：4.29 - 18.06），顺应性更好（WMD = -25.55，95%CI：-32.45至-18.64），排尿后残余尿量更多（WMD = -23.48，95%CI：-36.75至-10.21）；两组间最大排尿流速或排尿量无显著差异（WMD = -1.00，95%CI：-3.73 - 1.73）（WMD = -27.00，95%CI：70.05 - 16.06）。两组间血清肌酐无显著差异（WMD = -0.05，95%CI：-0.12 - 0.03）。
回肠新膀胱似乎能提供更高的患者满意度，而乙状结肠新膀胱可能提供更好的自主排尿机会。本荟萃分析可为泌尿外科医生为接受根治性膀胱切除术的患者选择理想的膀胱替代物提供一些有用的证据。
