How close are we to knowing whether orthotopic bladder replacement surgery is the new gold standard?--evidence from a systematic review update.
OBJECTIVE
To compare the clinical effectiveness and risk profile of the different types of surgeries using transposed intestinal segments in a systematic review update. Urinary diversion is designed to improve or replace the function of the diseased urinary bladder.


METHODS
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 year were included. This is a substantive update of our previously published systematic review that reported on the evidence between January and to January 2003 (Nabi G, Yong SM, Ong E, et al. J Urol. 2005;174:21-28).


RESULTS
Between January 1990 and January 2007, a total of 5651 abstracts were reviewed. Of them, 557 studies met the inclusion criteria reporting on 46,921 participants (an additional 14,126 participants reported on between January 2003 and January 2007). Operative complications were lowest in ileal conduit diversion, whereas postoperative morbidity and mortality were lower for orthotopic bladder replacement surgery. Of the 35 quality-of-life studies, only 2 studies (Dutta SC, Chang SC, Coffey CS, et al. J Urol. 2002;168:164-167; Hobisch A, Tosun K, Kinzl J, et al. World J Urol. 2000;18:338-344) reported a better quality of life with orthotopic bladder replacement.


CONCLUSIONS
This systematic review update fails to reveal a clear winner, with each intervention type having advantages and disadvantages. With > 46,000 patients included in transposed intestinal segment research over the past 16 years, it is surely a criticism of our speciality that we are no closer to answering the question of what is the best way to improve or replace the function of the diseased bladder.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom. bhaskarsomani@yahoo.com
Bhaskar K
BK
Somani
Ghulam
G
Nabi
Suzie
S
Wong
Margaret
M
Lyttle
Kofi
K
Atiemo
Gladys
G
McPherson
James
J
N'Dow
D006801:Humans; D011795:Surveys and Questionnaires; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods / Q000592:standards*; D016476:Urinary Reservoirs, Continent / Q000592:standards*