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International Journal of Clinical... Sep 2021This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD)... (Review)
Review
This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD) urinary diversion following robot-assisted radical cystectomy (RARC). A systematic literature search of articles was performed in PubMed, Web of Science, and Scopus databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We included studies that compared patients who underwent RARC with ICUD to those with ECUD. Twelve studies including 3067 patients met the eligibility criteria. There were no significant differences between ICUD and ECUD in overall and major complications, regardless of the period (short-term [≤ 30 days] or mid-term [> 30 days]). Subgroup analyses demonstrated that ICUD performed by high-volume centers exhibited a significantly reduced risk of major complications (short-term: OR 0.57, 95% CI 0.37-0.86, p = 0.008, mid-term: OR 0.66, 95% CI 0.46-0.94, p = 0.02). Patients who underwent ICUD had lower estimated blood loss (MD -102.3 ml, 95% CI - 132.8 to - 71.8, p < 0.00001), less likely to receive blood transfusion rates (OR 0.36, 95% CI 0.20-0.62, p = 0.00003); and these findings were consistent in subgroup analyses by low-volume centers (MD-121.6 ml, 95% CI - 160.9 to - 82.3, p < 0.00001 and OR 0.36, 95% CI 0.20-0.62, p = 0.00003, respectively). ICUD had a higher lymph node yield (MD 3.68, 95% CI 0.80-6.56, p = 0.01). Patients receiving ICUD provided comparable complications, superior perioperative outcomes, and similar oncological outcomes compared with ECUD. Centralization of patients may contribute to a reduction of postoperative complications, while maintaining the advantages.
PubMed: 34146185
DOI: 10.1007/s10147-021-01972-2 -
BJU International Mar 2024To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC),... (Review)
Review
OBJECTIVES
To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients.
METHODS
The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches.
RESULTS
Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison.
CONCLUSIONS
Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.
Topics: Humans; Female; Cystectomy; Urinary Bladder; Urinary Bladder Neoplasms; Urinary Incontinence; Urination; Urinary Diversion; Treatment Outcome
PubMed: 37562831
DOI: 10.1111/bju.16152 -
BMJ Clinical Evidence Mar 2007Ectopic endometrial tissue is found in up to 20% of asymptomatic women, up to 60% of those with dysmenorrhoea, and up to 30% of women with subfertility, with a peak... (Review)
Review
INTRODUCTION
Ectopic endometrial tissue is found in up to 20% of asymptomatic women, up to 60% of those with dysmenorrhoea, and up to 30% of women with subfertility, with a peak incidence at around 40 years of age. However, symptoms may not correlate with laparoscopic findings.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of hormonal treatments given at diagnosis of endometriosis? What are the effects of hormonal treatments before surgery for endometriosis? What are the effects of non-hormonal medical treatments for endometriosis? What are the effects of surgical treatments for endometriosis? What are the effects of hormonal treatment after conservative surgery for endometriosis? What are the effects of hormonal treatment after oophorectomy (with or without hysterectomy) for endometriosis? What are the effects of treatments for ovarian endometrioma? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 32 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: combined oral contraceptives; danazol; dydrogesterone; gestrinone; gonadorelin analogues; hormonal treatment before surgery; hormonal treatment; laparoscopic cystectomy; laparoscopic removal of endometriotic deposits (alone or with uterine nerve ablation); laparoscopic removal plus presacral neurectomy; laparoscopic uterine nerve ablation; non-steroidal anti-inflammatory drugs; presacral neurectomy alone; and progestogens other than dydrogesterone.
Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Contraceptives, Oral; Danazol; Dysmenorrhea; Endometriosis; Female; Humans; Laparoscopy; Progestins
PubMed: 19454060
DOI: No ID Found -
BJUI Compass Mar 2023Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high-risk non-muscle invasive bladder cancer. However, this... (Review)
Review
INTRODUCTION
Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high-risk non-muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ-sparing cystectomy (OSC) techniques are emerging as an alternative to the standard procedure to preserve these functions, without compromising the oncological outcomes. We present a systematic review and meta-analysis of the published literature.
METHODS
MEDLINE, Embase and Web of Science were systematically searched for eligible studies on 6 April 2021. Primary outcomes studied were both oncological outcomes, specifically overall recurrence, and functional outcomes, specifically sexual function, and daytime and nighttime continence. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated. The PROSPERO registration reference number was CRD42018118897.
RESULTS
From 13 894 identified abstracts, 19 studies (1886 male and 305 female patients) were eligible for inclusion in this review. These studies included patients who underwent either whole prostate, prostate capsule, seminal vesicle, nerve, uterus, ovary, vagina and fallopian tube sparing techniques. Four studies included only female patients.Thirteen studies reported oncological outcomes, and overall recurrence rate was similar between the two groups (five studies; OR 0.73; 95% CI 0.38-1.40, = 0.34). Thirteen studies reported on male sexual function. In men, OSC had significantly greater odds of retaining potency (five studies; OR 9.05; 95% CI 5.07-16.16, < 0.00001). Fourteen studies (13 on males and 1 female) reported urinary outcomes. In men, OSC demonstrated greater odds of daytime (seven studies; OR 2.61; 95% CI 1.74 to 3.92, < 0.00001) and nighttime continence (seven studies; OR 2.62; 95% CI 1.76 to 3.89, < 0.00001).
CONCLUSION
In carefully selected patients, OSC allows the potential to provide better sexual and urinary function without compromising oncological outcomes. There remains, however, a paucity of OSC studies in females. Further studies are required to make recommendations based on robust clinical evidence.
PubMed: 36816151
DOI: 10.1002/bco2.189 -
Urologic Oncology Feb 2018This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer.
OBJECTIVE
This study aimed to comprehensively analyze the oncological long-term outcomes of trimodal therapy (TMT) and radical cystectomy (RC) for the treatment of muscle-invasive bladder cancer (BC) with or without neoadjuvant chemotherapy (NAC).
PATIENTS AND METHODS
A systematic search was conducted according to the PRISMA guidelines for studies reporting on outcomes after TMT and RC. A total of 57 studies including 30,293 patients were included. The 10-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates for TMT and RC were assessed.
RESULTS
The mean 10-year OS was 30.9% for TMT and 35.1% for RC (P = 0.32). The mean 10-year DSS was 50.9% for TMT and 57.8% for RC (P = 0.26). NAC was administered before therapy to 453 (13.3%) of 3,402 patients treated with TMT and 812 (3.0%) of 27,867 patients treated with RC (P<0.001). Complete response (CR) was achieved in 1,545 (75.3%) of 2,051 evaluable patients treated with TMT. A 5-year OS, DSS, and RFS after CR were 66.9%, 78.3%, and 52.5%, respectively. Downstaging after transurethral bladder tumor resection or NAC to stage ≤pT1 at RC was reported in 2,416 (29.1%) of 8,311 patients. NAC significantly increased the rate of pT0 from 20.2% to 34.3% (P = 0.007) in cT2 and from 3.8% to 23.9% (P<0.001) in cT3-4. A 5-year OS, DSS, and RFS in downstaged patients (≤pT1) at RC were 75.7%, 88.3%, and 75.8%, respectively.
CONCLUSION
In this analysis, the survival outcomes of patients after TMT and RC for MIBC were comparable. Patients who experienced downstaging after NAC and RC exhibited improved survival compared to patients treated with RC only. Best survival outcomes after TMT are associated with CR to this approach.
Topics: Chemoradiotherapy, Adjuvant; Combined Modality Therapy; Cystectomy; Disease-Free Survival; Humans; Muscles; Neoadjuvant Therapy; Neoplasm Invasiveness; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 29102254
DOI: 10.1016/j.urolonc.2017.10.002 -
European Urology Oncology Apr 2020The complexity of bladder cancer diagnosis and staging results in delays in definitive treatment of muscle-invasive bladder cancer by radical cystectomy. (Meta-Analysis)
Meta-Analysis
CONTEXT
The complexity of bladder cancer diagnosis and staging results in delays in definitive treatment of muscle-invasive bladder cancer by radical cystectomy.
OBJECTIVE
This systematic review and meta-analyses aim to assess the impact of delays in radical cystectomy.
EVIDENCE ACQUISITION
A systematic review was conducted by searching Medline and Ovid Gateway using protocol-driven search terms in August 2019, with no time limit on the studies included. The identified studies were assessed according to strict criteria and using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) tool. Meta-analyses were conducted based on the type of delay. Random-effect models were used whereby the presence of a delay was the exposure variable and overall survival was the outcome of interest, for which pooled hazard ratios were calculated.
EVIDENCE SYNTHESIS
Nineteen studies were eligible for inclusion (17 532 patients), of which 10 were included in the meta-analyses. A longer delay between bladder cancer diagnosis and radical cystectomy resulted in a pooled hazard ratio of 1.34 (95% confidence interval [CI]: 1.18-1.53) for overall death. For a delay between transurethral resection and cystectomy, we found a pooled hazard ratio of 1.18 (95% CI: 0.99-1.41) for overall death. A pooled hazard ratio of 1.04 (95% CI: 0.93-1.16) was calculated for a longer delay between neoadjuvant chemotherapy and radical cystectomy.
CONCLUSIONS
A delay in radical cystectomy after diagnosis was found to have a significantly detrimental effect on overall survival for bladder cancer patients. However, there was huge heterogeneity in how a delay was defined.
PATIENT SUMMARY
In this review, we investigated the effect of a delay in radical treatment on survival. This review highlights the importance of scheduling radical cystectomies in a timely manner whilst monitoring factors such as comorbidities and scheduling, in order to treat patients requiring radical cystectomy without delay.
Topics: Cystectomy; Humans; Survival Analysis; Urinary Bladder Neoplasms
PubMed: 31668714
DOI: 10.1016/j.euo.2019.09.008 -
Urologic Oncology Feb 2018Currently, identified factors for urethral recurrence (UR) are based on individual reporting which has displayed controversy. In addition, risk of UR is one of the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Currently, identified factors for urethral recurrence (UR) are based on individual reporting which has displayed controversy. In addition, risk of UR is one of the limiting factors to offer neobladder diversion during radical cystectomy (RC). We aim to systematically evaluate the incidence and risk factors of UR post-RC and its effect on survival.
MATERIALS AND METHODS
A systematic online search was conducted according to PRISMA statement for publications reporting on UR after RC. From initial 802 results, 14 articles including 6169 patients were included finally after exclusion of ineligible studies.
RESULTS
The incidence rate of UR was 4.4% (1.3%-13.7%). It was significantly lower with neobladder diversion (odds ratio = 0.44, 95% CI: 0.24-0.79, P = 0.006). Muscle invasion (hazard ratio = 1.18, 95% CI: 0.86-1.62, P = 0.31), carcinoma in situ (hazard ratio 0.97, 95% CI: 0.64-1.47, P = 0.88), prostatic stromal involvement (hazard ratio = 2.26, 95% CI: 0.01-627.75, P = 0.78), and prostatic urethral involvement (hazard ratio = 2.04, 95% CI: 0.20-20.80, P = 0.55) have no significant effect on UR. Men displayed tendency toward higher incidence of UR (odds ratio = 2.21, 95% CI: 0.96-5.06, P = 0.06). Absence of recurrence displayed tendency toward better disease specific survival, yet not significant (hazard ratio = 0.84, 95% CI: 0.66-1.08, P = 0.17). These results are limited by the retrospective nature of the included studies.
CONCLUSION
Muscle invasion, carcinoma in situ and prostatic stromal or urethral involvement at time of RC have no significant effect on UR. Orthotopic neobladder is associated with a significant lower risk of UR after RC.
Topics: Carcinoma, Transitional Cell; Cystectomy; Humans; Kaplan-Meier Estimate; Neoplasm Recurrence, Local; Risk Factors; Urethra; Urinary Bladder; Urinary Bladder Neoplasms
PubMed: 29196179
DOI: 10.1016/j.urolonc.2017.11.007 -
Annals of Surgical Oncology May 2023This is a summary of existing systematic reviews comparing robotic assisted radical cystectomy (RARC) with open radical cystectomy (ORC). Our aim was to compare... (Review)
Review
This is a summary of existing systematic reviews comparing robotic assisted radical cystectomy (RARC) with open radical cystectomy (ORC). Our aim was to compare operative approaches with respect to perioperative, postoperative, oncologic, and health-related quality of life (QOL) outcomes. We performed a systematic review of MEDLINE, Medline-in-Process and Medline Epubs Ahead of Print, and the Cochrane Library on 22 February 2022. We included reviews of adult patients with bladder cancer undergoing RARC or ORC for muscle invasive or high-risk non-muscle invasive bladder cancer. Nonrandomized studies were excluded to minimize confounding and selection bias. The GRADE approach was used to determine the confidence in estimates. We assessed the quality of identified systematic reviews using AMSTAR 2 checklist. Six well-conducted, systematic reviews and meta-analyses were included. RARC was consistently associated with lower estimated blood loss (EBL) and transfusion rates, and longer operative time. There was inconsistent evidence for the impact of RARC on hospital length of stay (LOS). There was no significant difference in overall complication rate or major complication rate, or oncologic outcomes between groups. Comparison of QOL outcomes between studies was limited by statistical and methodological heterogeneity. RARC is associated with improvement in EBL and transfusion risk. There does not appear to be differences in oncologic outcomes or complications between approaches. Prospective studies are needed to assess the impact of diversion type, technique, and recovery pathways on patient outcomes and to assess the impact of operative approach on cost and patient-reported QOL.
Topics: Adult; Humans; Cystectomy; Quality of Life; Robotic Surgical Procedures; Treatment Outcome; Postoperative Complications; Urinary Bladder Neoplasms
PubMed: 36774434
DOI: 10.1245/s10434-022-12692-w -
PloS One 2015To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC).
METHODS
A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in April 2014. All relevant studies comparing RARC with ORC were included for further screening. A pooled meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.
RESULTS
Nineteen studies were included for the analysis, including a total of 1779 patients (787 patients in the RARC group and 992 patients in the ORC group). Although RARC was associated with longer operative time (p <0.0001), patients in this group might benefit from significantly lower overall perioperative complication rates within 30 days and 90 days (p = 0.005 and 0.0002, respectively), more lymph node yields (p = 0.009), less estimated blood loss (p <0.00001), lower need for perioperative and intraoperative transfusions (p <0.0001 and <0.0001, respectively), and shorter postoperative length of stay (p = 0.0002). There was no difference between two groups regarding positive surgical margin rates (p = 0.19).
CONCLUSIONS
RARC appears to be an efficient alternative to ORC with advantages of less perioperative complications, more lymph node yields, less estimated blood loss, lower need for transfusions, and shorter postoperative length of stay. Further studies should be performed to compare the long-term oncologic outcomes between RARC and ORC.
Topics: Cystectomy; Female; Humans; Male; Middle Aged; Robotics
PubMed: 25825873
DOI: 10.1371/journal.pone.0121032 -
Knee Surgery & Related Research Jun 2019To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy.
PURPOSE
To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy.
METHODS
PubMed/MEDLINE, EMBASE, KoreaMed, and Cochrane Library were searched from the earliest available date of indexing through August 2016. The methodological quality of all articles was assessed according to the Coleman methodology score (CMS). Studies were grouped according to the surgical method, and a meta-analysis was conducted to identify the unsuccessful clinical outcome and complication rates.
RESULTS
Nine studies were included; the mean CMS was 67.33 (standard deviation, 8.75 points). Cystectomy was reported in five studies; cystectomy was not performed in four studies. The odds ratio of unsuccessful clinical outcomes evaluated by Rauschning and Lindgren score was 122.05 (p<0.001) with cystectomy and 58.12 (p<0.001) without cystectomy. The effect size of complications was 0.16 (p<0.001) with cystectomy and 0.03 (p<0.001) without cystectomy. The recurrence rate was 0% with cystectomy and 6.4% without cystectomy.
CONCLUSIONS
All the currently available studies showed satisfactory outcomes in both with and without cystectomy groups. However, arthroscopic cystectomy concurrently performed with management of intra-articular lesions was associated with a relatively low recurrence rate and a relatively high incidence of complications.
PubMed: 30893988
DOI: 10.5792/ksrr.18.068