Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Int J Surg. 2019 Dec;72:80-84. doi: 10.1016/j.ijsu.2019.10.023. Epub 2019 Nov 1.
Proper techniques used in procedures might play an important role in reducing ureteroileal anastomosis stricture (UIAS) for patients undergoing orthotopic neobladder. The present study was to evaluate the efficacy of internal double-J stent versus external ureteral catheter on UIAS for patients undergoing radical cystectomy and orthotopic neobladder.
A comprehensive search of the literature referring to the topic was performed on 10th January 2019 in PubMed, EMBASE and Google Scholar, by using key words as radical cystectomy, orthotopic neobladder, stricture, stenosis. The Cochrane Collaboration's RevMan 5.3 software was employed for data analysis. The incidence of UIAS was evaluated as primary outcome.
Five studies were included eventually. The incidence of UIAS was lower in the group of internal double-J stent than that in the group of external ureteral catheter (odds ratio [OR], 0.49; 95% CI, 0.25-0.97; p = 0.04) with a low heterogeneity (I = 0%). Besides, internal double-J stent group had a trend of a shorter length of stay than external ureteral catheter group.
Based on the present meta-analysis, internal double-J stent placement was associated with a lower incidence of UIAS than external ureteral catheter for patients undergoing orthotopic neobladder. In addition, a trend of a shorter hospital stay was also detected, thus, internal double-J stent placement may be favored in the view of the enhanced recovery after surgery (ERAS).
在进行原位新膀胱术时，正确的手术技术可能对减少输尿管-回肠吻合口狭窄（UIAS）起着重要作用。本研究旨在评估经皮肾镜内双 J 支架与经皮肾镜外输尿管导管在根治性膀胱切除术和原位新膀胱术患者中对 UIAS 的疗效。
于 2019 年 1 月 10 日，我们通过关键词“根治性膀胱切除术、原位新膀胱、狭窄、狭窄”，在 PubMed、EMBASE 和 Google Scholar 中对文献进行了全面检索，评估了经皮肾镜内双 J 支架与经皮肾镜外输尿管导管对根治性膀胱切除术和原位新膀胱术患者 UIAS 的影响。使用 Cochrane 协作 RevMan 5.3 软件进行数据分析。将 UIAS 的发生率作为主要结局进行评估。
最终纳入了 5 项研究。与经皮肾镜外输尿管导管组相比，经皮肾镜内双 J 支架组 UIAS 的发生率较低（比值比 [OR]，0.49；95%置信区间 [CI]，0.25-0.97；p=0.04），且异质性较低（I=0%）。此外，经皮肾镜内双 J 支架组的住院时间有缩短的趋势。
基于本荟萃分析，与经皮肾镜外输尿管导管相比，经皮肾镜内双 J 支架放置术可降低行原位新膀胱术患者 UIAS 的发生率。此外，还发现经皮肾镜内双 J 支架组的住院时间有缩短的趋势，因此，从术后加速康复（ERAS）的角度来看，经皮肾镜内双 J 支架放置可能更具优势。
