Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis

Background: Urinary diversion in bladder cancer treatment has been a distinguished topic of interest due to varying approaches available. Amongst them, ileal conduit (IC) and transuretero-ureterostomy (TUU) have been popular options in clinical practice. This study would like to compare the long-term outcomes of IC and TUU in patients undergoing RC procedures. Materials and methods: Literature searches were conducted in MEDLINE, CENTRAL, and EMBASE. Duration of hospitalization, complication rate, quality of life, and survival rate were selected as outcomes. Risk of bias was assessed using the ROBINS-I tool. Outcome measure was pooled using forest plot in Review Manager V.5 for Macintosh. Heterogeneity was measured using the DerSimonian and Laird random-effects model. Results: Eighteen matching interventional studies were included, 3 were prospective studies. The total number of included samples was 3,689; 1,172 patients of the TUU and 2,517 of IC group. The IC procedure associates with longer hospitalization [mean difference 3.80 [95% confidence interval (CI): 2.27-5.32), p < 0.001, I-2 = 92%]. Duration of intensive care did not differ significantly. There were no differences in major complication rates [odds ratio (OR) = 1.45, 95% CI: 0.74-2.84, p = 0.27, I-2 = 54%]: stone formation (OR = 1.07, 95% CI: 0.51-2.23, p = 0.48, I-2 = 0%), and renal function deterioration (OR = 0.81, 95% CI: 0.39-1.68, p = 0.57, I-2 = 0%) between the TUU and IC groups. Quality of life decreased in both groups, and only occurred in the early days after the stoma placement phase. Survival rates were not different among the groups. Conclusion: TUU is a better UD option as it offers shorter time of hospitalization, with the similar major complications, quality of life, and survival rate compared to IC.