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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 -
International Journal of Surgery... Feb 2023
Meta-Analysis
A commentary on 'systematic review and meta-analysis of randomized controlled trials of perioperative outcomes and prognosis of transurethral en-bloc resection versus conventional transurethral resection for nonmuscle-invasive bladder cancer' (Int J Surg 2022; 104:106777).
Topics: Humans; Randomized Controlled Trials as Topic; Urinary Bladder Neoplasms; Urologic Surgical Procedures; Prognosis; Cystectomy; Neoplasm Invasiveness
PubMed: 36799855
DOI: 10.1097/JS9.0000000000000097 -
Minerva Urology and Nephrology Apr 2023The aim of this study was to compare the perioperative outcomes of routine drainage insertion vs. no drainage in patients undergoing robot-assisted radical prostatectomy... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The aim of this study was to compare the perioperative outcomes of routine drainage insertion vs. no drainage in patients undergoing robot-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC).
EVIDENCE ACQUISITION
A literature search was conducted through April 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies.
EVIDENCE SYNTHESIS
Eleven studies comprising 8447 RARPs and 1890 RAPNs met our inclusion criteria. Our search strategy did not identify any studies within the RARC framework. In RARP, patients without postoperative drainage had lower rate of postoperative ileus (OR 0.53, 95% CI: 0.38 to 0.74; P<0.001) and similar low-grade (Clavien 1-2, P=0.41) and high-grade (Clavien ≥3; P=0.85) complications, urinary leakage (P=0.07), pelvic hematoma (P=0.35), symptomatic lymphocele (P=0.13), fever (P=0.25), incisional hernia (P=0.31), reintervention (P=0.57), length of hospital stay (P=0.22), and readmission (P=0.74) compared with routinely drained patients. In RAPN, patients without postoperative drainage had shorter length of hospital stay (mean difference: -0.84 days, 95% CI: -1.06 to -0.63; P<0.001) and similar low-grade (P=0.94) and high-grade (P=0.31) complications, urinary leakage (P=0.49), hemorrhage (P=0.39), reintervention (P=0.69), and readmission (P=0.20) compared with routinely drained patients.
CONCLUSIONS
In our study, patients without drainage had similar perioperative course to patients with prophylactic drain insertion after RARP and RAPN. Omission of drain insertion was associated with a lower rate of postoperative ileus for RARP and a shorter hospital stay for RAPN. In the era of robotic surgery, routine drain placement is no longer indicated in unselected patients.
Topics: Male; Humans; Robotic Surgical Procedures; Laparoscopy; Prostate; Prostatectomy; Cystectomy; Postoperative Complications
PubMed: 36722161
DOI: 10.23736/S2724-6051.22.05160-6 -
European Urology Focus Jul 2023Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs)... (Review)
Review
CONTEXT
Patients undergoing radical cystectomy frequently suffer from infectious complications, including urinary tract infections (UTIs) and surgical site infections (SSIs) leading to emergency department visits, hospital readmission, and added cost.
OBJECTIVE
To summarize the literature regarding perioperative antibiotic prophylaxis, ureteric stent usage, and prevalence of infectious complications after cystectomy.
EVIDENCE ACQUISITION
A systematic review of PubMed/Medline, EMBASE, Cochrane Library, and reference lists was conducted.
EVIDENCE SYNTHESIS
We identified 20 reports including a total of 55 306 patients. The median rates of any infection, UTIs, SSIs, and bacteremia were 40%, 20%, 11%, and 6%, respectively. Perioperative antibiotic prophylaxis differed substantially between reports. Perioperative antibiotics were used only during surgery in one study but were continued over several days after surgery in all other studies. Empirical use of antibiotics for 1-3 d after surgery was described in 12 studies, 3-10 d in two studies, and >10 d in four studies. Time to stent removal ranged from 4 to 25 d after cystectomy. Prophylactic antibiotics were used before stent removal in nine of 20 studies; two of these studies used targeted antibiotics based on urine cultures from the ureteric stents, and the other seven studies used a single shot or 2 d of empirical antibiotics. Studies with any prophylactic antibiotic before stent removal found a lower median percentage of positive blood cultures after stent removal than studies without prophylactic antibiotics before stent removal (2% vs 9%).
CONCLUSIONS
We confirmed a high proportion of infectious complications after cystectomy, and a heterogeneous pattern of choice and duration of antibiotics during and after surgery or stent removal. These findings highlight a need for further studies and support quality prospective trials.
PATIENT SUMMARY
In this review, we observed wide variability in the use of antibiotics before or after surgical removal of the bladder.
Topics: Humans; Antibiotic Prophylaxis; Cystectomy; Prospective Studies; Anti-Bacterial Agents; Surgical Wound Infection; Urinary Tract Infections; Stents
PubMed: 36710211
DOI: 10.1016/j.euf.2023.01.012 -
Annals of Joint 2023This systematic review aims to determine the best modality for the management of meniscal cysts and its associated meniscus tear; whether the meniscal cyst treated via... (Review)
Review
BACKGROUND
This systematic review aims to determine the best modality for the management of meniscal cysts and its associated meniscus tear; whether the meniscal cyst treated via arthroscopy or open methods and whether meniscal debridement or repair achieves better results.
METHODS
This systematic review was performed using PRISMA guidelines. A literature search of PubMed, EMBASE and Cochrane was carried out in July 2020 using the search terms 'meniscal cyst' and 'treatment'. All clinic studies that included filters for papers in the last 20 years, English language, and meniscal cysts found in humans were included. Studies that contained case reports, were in any language other than English, and with subjects that were not humans were excluded. The methodology quality assessment was performed through the modified Coleman methodology score (CMS).
RESULTS
A total of 166 results were obtained from PubMed, Cochrane library and EMBASE. Of them, 12 duplicates were identified across the databases and removed from consideration. Six papers were found relevant from EMBASE in which 1 was eventually included in this paper. In total, 12 papers were used in this study. The weighted mean age of the patients was 35.1 years, with total of 523 meniscal cysts, of which 488 of these cysts are associated with meniscal tears (93.31%). The studies included performed cystectomies and/or decompression of meniscal cysts while some left the meniscal cyst alone and dealt with the meniscal lesion instead. All clinical scores showed significant improvement following surgical procedures.
CONCLUSIONS
Both arthroscopic and open methods can be used for meniscal cysts treatment. Open cystectomy rather than decompression seemed to confer lower risk of cyst recurrences and complications. It is inconclusive to whether meniscal repair or meniscus debridement influenced recurrence and outcome scores. A recommendation for meniscus repair cannot be made due to insufficient high-quality level I or II trials.
PubMed: 38529257
DOI: 10.21037/aoj-22-29 -
Frontiers in Oncology 2022This study aims to determine the optimal pelvic lymph node dissection (PLND) template for radical cystectomy (RC).
OBJECTIVE
This study aims to determine the optimal pelvic lymph node dissection (PLND) template for radical cystectomy (RC).
METHODS
A systematic search was conducted using the PubMed, Embase and Cochrane Library database in December 2021. Articles comparing recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), and postoperative complications among patients undergoing limited PLND (lPLND), standard PLND (sPLND), extended PLND (ePLND), or super-extended PLND (sePLND) were included. A Bayesian approach was used for network meta-analysis.
RESULTS
We included 18 studies in this systematic review, and 17 studies met our criteria for network meta-analysis. We performed meta-analyses and network meta-analyses to investigate the associations between four PLND templates and the RFS, DSS, OS, or postoperative complications. We found that the ePLND group and the sePLND group were associated with better RFS than the sPLND group (Hazard Ratio [HR]: 0.65, 95% Credible Interval [CrI]: 0.56 to 0.78) (HR: 0.67, 95% CrI: 0.56 to 0.83) and the lPLND group (HR: 0.67, 95% CrI: 0.50 to 0.91) (HR: 0.70, 95% CrI: 0.49 to 0.99). For RFS, Analysis of the treatment ranking revealed that ePLND had the highest probabilities to be the best template. There was no significant difference between the four templates in DSS, however, analysis of the treatment ranking indicated that sePLND had the highest probabilities to be the best template. And We found that the sePLND group and the ePLND group were associated with better OS than lPLND (HR: 0.58, 95% CrI: 0.36 to 0.95) (HR: 0.63, 95% CrI: 0.41 to 0.94). For OS, analysis of the treatment ranking revealed that sePLND had the highest probabilities to be the best template. The results of meta-analyses and network meta-analyses showed that postoperative complications rates did not differ significantly between any two templates.
CONCLUSION
Patients undergoing sePLND and ePLND had better RFS but not better DSS or OS than those undergoing lPLND or sPLND templates, however, RFS did not differ between patients undergoing sePLND or ePLND. Considering that sePLND involves longer operation time, higher risk, and greater degree of difficulty than ePLND, and performing sePLND may not result in better prognosis, so it seems that there is no need for seLPND. We think that ePLND might be the optimal PLND template for RC.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022318475.
PubMed: 36505883
DOI: 10.3389/fonc.2022.986150 -
Frontiers in Oncology 2022This study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of...
BACKGROUND
This study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of bladder cancer.
METHODS
Two researchers independently searched PubMed, Embase, Cochrane, and CBM using the index words to identify the qualified studies which included randomized controlled trials (RCTs) and non-randomized controlled trials (prospective and retrospective studies), and the investigators scanned references of these articles to prevent missing articles. Differences in clinical outcomes between the two procedures were analyzed by calculating odds risk (OR) and mean difference (MD) with an associated 95% confidence interval (CI).
RESULTS
Sixteen comparative studies were included in the meta-analysis with 1467 patients in the RARC group and 897 patients in the LRC group. The results indicated that RARC could significantly decrease blood loss ( = 0.01; MD: -82.56, 95% CI: -145.04 to -20.08), and complications 90 days or more after surgery, regardless of whether patients were Grade ≤ II ( = 0.0008; OR: 0.63, 95% CI: 0.48 to 0.82) or Grade ≥ III ( = 0.006; OR: 0.59, 95% CI: 0.40 to 0.86), as well as overall complications (: 0.01; OR = 0.52; 95% CI: 0.32 to 0.85). However, there was no statistical difference between the two groups at total operative time, intraoperative complications, transfusion rate, short-term recovery, hospital stay, complications within 30 days of surgery, and bladder cancer-related mortality.
CONCLUSIONS
The meta-analysis demonstrates that RARC is a safe and effective treatment for bladder cancer, like LRC, and patients with RARC benefit from less blood loss and fewer long-term complications related to surgery, and should be considered a viable alternative to LRC. There still need high-quality, larger sample, multi-centric, long-term follow-up RCTs to confirm our conclusion.
PubMed: 36439450
DOI: 10.3389/fonc.2022.1024739 -
Cancers Nov 2022(1) Purpose: To assess the survival benefit for different times to adjuvant chemotherapy after a radical cystectomy. (2) Materials and Methods: We systematically... (Review)
Review
(1) Purpose: To assess the survival benefit for different times to adjuvant chemotherapy after a radical cystectomy. (2) Materials and Methods: We systematically searched PubMed, Cochrane Central, Scopus, and Web of Science library databases for original articles that looked at timing to adjuvant chemotherapy after radical cystectomy. Primary endpoints were five-year survival, progression free survival, and overall survival. Available multivariable hazard ratios and corresponding 95% CIs were included in the qualitative analysis. The risk of bias was completed for nonrandomized studies. (3) Results: Using PRISMA guidelines, our electronic search resulted in a total of 1862 records. After a detailed review, we selected four studies that addressed the impact of the timing of adjuvant chemotherapy for patients who underwent radical cystectomy. (4) Conclusion: A survival benefit was seen with an earlier administration of adjuvant chemotherapy, albeit a benefit persists for delayed chemotherapy post-radical cystectomy. A safe and ethical approach at this time would be to administer adjuvant chemotherapy as early in the postoperative period as possible, given the known survival benefit of such therapy (9-11% absolute survival benefit at five years).
PubMed: 36428737
DOI: 10.3390/cancers14225644 -
Urologia Internationalis 2023Mortality after radical cystectomy (RC) varies widely in the literature. In cohort studies, mortality rates can vary from as low as 0.5% in large-volume academic centers...
INTRODUCTION
Mortality after radical cystectomy (RC) varies widely in the literature. In cohort studies, mortality rates can vary from as low as 0.5% in large-volume academic centers (2) to as high as 25% in developing countries series. This study aims to perform a systematic review of population-based studies reporting mortality after RC.
METHODS
A Systematic search was performed in Medline (PubMed®), Embase, and Cochrane for epidemiologic studies reporting mortality after RC. Institutional cohorts and those reporting mortality for specific groups within populations were excluded. Case series and non-epidemiologic series were also excluded. The aim of this review is to evaluate in-hospital mortality (IHM), 30-day mortality (30M), and 90-day mortality (90M).
RESULTS
Systematic search resulted in 42 papers comprising 449,661 patients who underwent RC from 1984 to 2017. Mean age was 66.1. Overall IHM, 30M, and 90M were 2.6%, 2.7%, and 4.9%, respectively, with 90M being 2.6 times higher than IHM on average. Lowest IHM was found in Canada and Australia (0.2% and 0.6%, respectively), while the highest IHM was 7.8% (Brazil). Canada and Spain showed the highest 90M (6.5%). 159,584 urinary diversions were analyzed, being mostly ileal conduits (76.8%).
CONCLUSIONS
The majority of the studies available are from major developed economies with paucity of data in the developing world. 90M after RC tends to be at least twice as high as IHM. The knowledge of such epidemiologic data is vital to guide public policies, such as centralization, in order to reduce mortality.
Topics: Humans; Aged; Cystectomy; Urinary Bladder Neoplasms; Urinary Bladder; Urinary Diversion; Hospital Mortality
PubMed: 36382647
DOI: 10.1159/000524578 -
Fertility and Sterility Dec 2022To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether cystectomy or ablation for endometrioma has less impact on ovarian reserve as evaluated by antral follicle count (AFC) and antimüllerian hormone (AMH) levels.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Patients with endometriomas undergoing cystectomy or ablation.
INTERVENTION(S)
All prospective studies comparing cystectomy with ablation for endometrioma in the PubMed, EMBASE, MEDLINE and Web of Science until April 3, 2022 were retrieved and reviewed. Medical treatment used as adjuvant therapy for the surgery was excluded. Two authors assessed eligibility and risk of bias independently. The statistical data were pooled using the Review Manager software.
MAIN OUTCOME MEASURE(S)
The changes of AMH levels and AFC values in cystectomy group and ablation group, including intergroup comparisons and intragroup comparisons.
RESULT(S)
Four randomized clinical trials and 2 prospective cohort studies were eligible for the meta-analysis, with a total of 294 patients. In the intergroup comparisons, preoperative AFC values were similar with low heterogeneity, but postoperative AFC values were significantly lower in cystectomy than ablation (mean differences [MD], -1.33; 95% credible interval, -2.15 to -0.51; I = 57%). In the intragroup comparisons of AFC values, sensitivity analyses showed a significant decrease in cystectomy (MD, -1.93; 95% credible interval, -2.40 to -1.45; I = 0%) at 6-month follow-up, compared with no reduction in ablation. The intragroup comparisons of AMH levels supported negative effects on ovarian reserve of both cystectomy (MD, -1.26; 95% credible interval, -1.64 to -0.88; I = 45%) and ablation (MD, -0.70; 95% credible interval, -1.07 to -0.32; I = 0%).
CONCLUSION(S)
Both ablation and cystectomy have significantly detrimental effects on ovarian reserve as evaluated by AMH, but the ablation causes relatively less damage to ovarian reserve as appraised by AFC.
CLINICAL TRIAL REGISTRATION NUMBER
CRD42020152823;PROSPERO (york.ac.uk).
Topics: Female; Humans; Ovarian Reserve; Prospective Studies; Laparoscopy; Endometriosis; Anti-Mullerian Hormone
PubMed: 36334993
DOI: 10.1016/j.fertnstert.2022.08.860