Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Minerva Urol Nefrol. 2020 Aug;72(4):408-419. doi: 10.23736/S0393-2249.20.03641-3.
Radical cystectomy (RC) and urinary diversion (UD) are two steps of the same surgical procedure involving likely complications and important impact on quality of life (QoL). The literature was reviewed to identify recent studies reporting UDs complications occurred 90 days after surgery and graded by Clavien-Dindo Classification System (CCS).
A comprehensive systematic Medline search was performed in PubMed/Medline, Embase and Scopus databases to identify reports published in English starting from 2013 using key words related to review outcome (i.e. neobladder, ileal conduct, ureterocutaneostomy, cystectomy, QoL). Complications were defined as minor or major whether the CCS grade was ≤2 or ≥3, respectively. Then, manuscripts references were screened to identify unfounded studies. Only studies using CCS to report surgical complications were considered.
Retrieved studies were reported according to two main items of complications and QoL. About UDs complications, fourteen studies were identified incorporating overall 4436 patients. Up to 50% of patients experienced at least one low-grade complications (CCS≤2) requiring pharmacological treatment to be healed. On the other hand, high-grade complications (CCS≥3) occurred in 0.7-42% of cases and required surgical interventions (CCS 3a and 3b) or life support (CCS=4). Finally, mortality (CCS=5) rated between 0.4-7%. Regarding QoL, six studies were analyzed with overall 445 patients. Most of them were retrospective and showed conflicting results whether the external UDs were better than neobladder in term of impact on QoL.
The use of a standardized system such as CCS improves analyses of literature. However, rigorous patient selection for UD type makes unable a randomized comparison between UDs in terms of complications and QoL impact.
根治性膀胱切除术（RC）和尿流改道术（UD）是同一手术过程的两个步骤，涉及可能的并发症和对生活质量（QoL）的重要影响。本文回顾了文献，以确定最近报道的术后 90 天发生的 UD 并发症的研究，并使用 Clavien-Dindo 分类系统（CCS）进行分级。
在 PubMed/Medline、Embase 和 Scopus 数据库中进行了全面的系统 Medline 搜索，以查找自 2013 年以来用与综述结果相关的关键词发表的英文报告（即新膀胱、回肠导管、输尿管皮造口术、膀胱切除术、QoL）。并发症定义为 CCS 分级≤2 时为轻度或重度，≥3 时为重度。然后，筛选手稿参考文献以确定无根据的研究。仅考虑使用 CCS 报告手术并发症的研究。
根据并发症和 QoL 的两个主要项目报告了检索到的研究。关于 UD 并发症，确定了 14 项纳入了 4436 例患者的研究。高达 50%的患者经历了至少一种低级别并发症（CCS≤2），需要药物治疗才能愈合。另一方面，发生高级别并发症（CCS≥3）的病例占 0.7-42%，需要手术干预（CCS 3a 和 3b）或生命支持（CCS=4）。最后，死亡率（CCS=5）为 0.4-7%。关于 QoL，分析了 6 项纳入 445 例患者的研究。它们大多是回顾性的，关于外部 UD 对 QoL 的影响是否优于新膀胱，结果存在冲突。
使用 CCS 等标准化系统可提高文献分析的水平。然而，UD 类型的严格患者选择使得无法在并发症和 QoL 影响方面对 UD 进行随机比较。
