Comparison Of Efficacy Between Orthotopic Ileal Neobladder And Orthotopic Sigmoid Neobladder:A Meta-analysis

Objective:This research probes into the advantages and disadvantages of orthotopic ileal neobladder and sigmoid neobladder in selecting a kind of reconstructive material with convenient operation,less complications,more consistent with the urodynamic and continent status of the primary bladder.Methods:PubMed,Embase,the Cochrane Library,Wiley,CNKI,Wanfang Data,and VIP database are searched systematically to find randomized controlled trials(RCTs)and cohort studies,which discussed the incidence of postoperative complications,urodynamic and continent parameters in patients underwent orthotopic ileal and sigmoid neobladder,published before September,2018.Two researchers independently screened literature,assessed the quality of included studies and extract data.Then Meta-analysis was performed by using STATA 14.0 software.Results:A total of 17 studies were included in this Meta-analysis,including 2 RCTs,1prospective cohort study,and 14 retrospective cohort studies with a total of 1,387 patients.The results of Meta-analysis showed that: there was no significant difference in the total incidence of early and late complications between ileal and sigmoid groups(RR=1.054,P=0.664;RR=1.075,P=0.607).According to the urodynamic study,ileal neobladder exhibited larger capacity(WMD=49.515,P=0.000),better compliance(WMD=21.638,P=0.000),larger post-voiding residual volume(WMD=5.924,P=0.000)and lower pressure at max capacity(WMD=-2.481,P=0.000);There was no significant difference in the max voiding flow rate between the two groups(WMD=0.093,P=0.717).There was no significant difference in daytime continence rate between the two groups(RR=0.771,P=0.087),but both daytime continence rate were significantly higher than nighttime continence rate in the two groups(RR=0.494,P=0.000;RR=0.438,P=0.000).The nighttime continence rate was significantly higher in ileal group than in sigmoid group(RR=0.701,P=0.000).Conclusions:Ileal neobladder is more effective than sigmoid neobladder in providing patients with bladders with larger capacity,better compliance,lower pressure and higher continence rate,although sigmoid neobladder may enable patients to experience a better sense of voiding.Thus,this study suggests that ileal is more suitable than sigmoid for reconstructing a new bladder.