Words of Wisdom. Re: how close are we to knowing whether orthotopic bladder replacement surgery is the new gold standard? Evidence from a systematic review update.

摘要

Urinary diversion is designed to improve or replace the function of the diseased urinary bladder. In this systematic review, the authors compare the clinical effectiveness and risk profiles of different types of urinary diversion.Studies reporting on surgery involving intestinal segments transposed into the urinary tract were identified between January 1990 and January 2007 using Medline, PubMed, Embase, CINAHL, and the Cochrane Library. All articles published in English language reporting on at least 10 patients and follow-up of at least 1 yr were included.A total of 5651 abstracts were reviewed. Of them, 557 studies met the inclusion criteria, reporting on 46 921 participants. Operative complications were lowest in ileal conduit diversion, whereas postoperative morbidity and mortality were lower for orthotopic bladder replacement. Of the 35 quality-of-life (QpL) studies, only 2 [1,2] reported a better quality of life with orthotopic bladder replacement.