Available online 28 May 2024, 102090

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Using PRISMA guidelines, we performed a systematic review assessing peri- and post-procedural complications and long-term outcomes of different surgical approaches of ONs finding that despite early and late complications rates were generally low, caution should be posed to detect and treat infective and urinary leakage complications.

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The current body of evidence in the published literature is still insufficient to assess that any form of UD is superior to the other based on health related QoL and complications outcomes.

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Further studies with longer follow-ups are needed.

Abstract

Bladder cancer (BCa) represents the second most common malignancy of the genitourinary tract. The major risk factors include age, gender, smoking attitude, and occupational exposure, while the exact etiopathogenesis is still uncertain. Patients diagnosed with a BCa showing invasion of the muscle layer below the submucosa must undergo radical cystectomy (RC) with urinary diversion (UD). Many different surgical approaches to UD have been developed. Packaging an orthotopic neobladder (ON) with a bowel tract represents the gold standard when certain patient selection criteria are satisfied. Using PRISMA guidelines, we performed a systematic review assessing early (within 90 days) and late (beyond 90 days) post-procedural complications of different ON surgical approaches. A comprehensive systematic search was conducted in PubMed, Scopus, and Google Scholar databases to identify papers starting from 2012 using dedicated keywords (“neobladder”, “orthotopic neobladder”, “complications'' and “outcomes”). A total of 27 articles were found to satisfy the inclusion criteria and selected. Although the ON is a safe procedure that guarantees the patient the best quality of life (QoL), it is not free from risks. Many complications could occur during and after the surgical time which imposes the necessity of strict follow-up and careful checks over time, which should be properly discussed with patients before.

Section snippetsINTRODUCTION

Bladder cancer (BCa) affects millions of people worldwide and it is the most frequent tumor in the urinary tract, representing the seventh most diagnosed type in men’s population and the tenth when considering both sexes (Cumberbatch, Noon, e Party 2019). It hugely shows variable age-standardized incidence and mortality rates (per 100,000 person/year) between the two sexes, reaching 9.5 and 3.3 in men and 2.4 and 0.86 in women respectively (Mohammadian et al. 2020). This heterogeneity is even

Results

Surgical morbidity could be divided into early (up to 90 days after surgery) and late complications (>90 days after surgery). Despite the delineation of these categories, their boundaries may not always be sharply defined and may vary even in terms of the postoperative timeframe. Surgical morbidity in patients undergoing ON procedures can manifest both preoperatively and postoperatively. Overall, the neobladder management and thus the potential complications could be divided into three phases:

Discussion

ON reconstruction, followed by ileal conduit diversion, represents the most performed reconstruction after radical cystectomy (Chang e Lawrentschuk 2015). The major advantage of this type of reconstruction is certainly related to the improvement in quality of life due to providing patients with a method of urinating without a stoma or urine bag (Biardeau et al. 2020). Nevertheless, ON reconstruction is a challenging procedure and requires the integrity of the external sphincter, an unobstructed

Conclusions and Future Perspectives

The orthotopic neobladder reconstruction represents a valid alternative to other types of reconstruction in bladder cancer patients undergoing radical cystectomy. Nevertheless, despite early and late complications rates being generally low, caution should be posed to detect and treat infective and urinary leakage complications even though the current body of evidence in the published literature is still insufficient to assess that any form of UD is superior to the another based on

Uncited reference

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Declaration of Competing Interest

All authors have no conflict of interest.

All have no direct or indirect commercial financial incentive associated with publishing the article.

No financial support has been received for this research/study.

No funding agreement limits our ability fairly to complete and publish our research/study.

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