RESUMEN
INTRODUCTION: We aimed to perform a systematic review and meta-analysis on the long-term durability, incidence of complications, and patient satisfaction outcomes in ileal conduit (IC) and orthotopic neobladder (ONB). METHODS: A systematic electronic literature search was performed in Medline, Embase, Cochrane Library, and Scopus using MeSH and free-text search terms "Urinary diversion" AND "Ileal conduit" AND "Neobladder." The search concluded June 19, 2018. Inclusion criteria were those patients who had a cystectomy and required urinary diversion by either IC or neobladder. RESULTS: In total, 32 publications met the inclusion criteria. Data were available on 46 787 patients (n=36 719 for IC and n=10 068 for ONB). Meta-analyses showed that IC urinary diversions performed less favorably than ONB in terms of re-operation rates, Clavien-Dindo complications, and mortality rates; odds ratios (ORs) and 95% confidence intervals (CIs) were 1.76 (1.24, 2.50), p<0.01; 1.16 (1.09, 1.22), p<0.01; and 6.29 (5.30, 7.48), p<0.01, respectively. IC urinary diversion performed better than ONB in relation to urinary tract infection rates and ureteric stricture rates, OR and 95% CI 0.67 (0.58, 0.77), p<0.01; and 0.70 (0.55, 0.89), p<0.01, respectively. CONCLUSIONS: Our results show that there is no significantly increased morbidity with ONB compared to IC. Selection of either urinary diversion technique should be based on factors such as tumor stage, comorbidities, surgical experience, and patient acceptance of postoperative sequalae.
RESUMEN
Purpose: To demonstrate the various antegrade and retrograde endourologic approaches that may be required for effectively treating kidney transplant recipients presenting with ureteral obstruction caused by urolithiasis. Materials and Methods: We prospectively evaluated endoscopic management techniques of renal transplant recipients referred to a national kidney transplant center with obstructing transplant ureteral calculi for a 12-month period (April 2019-April 2020). Results: Four kidney transplant recipients presented with ureteral obstruction caused by urolithiasis and the mean age was 66.6 (range: 62-71) years. The mean duration from renal transplantation was 16 (range: 6-25) years. Three patients presented with acute urosepsis and one patient presented with malaise and recurrent urinary tract infections. Two patients were definitively treated with percutaneous antegrade flexible ureteroscopic lithotripsy through a 16F minipercutaneous nephrolithotomy sheath. Two patients were definitively treated with retrograde flexible ureteroscopy (7F single-use disposable ureteroscope) and laser lithotripsy. Full stone clearance was achieved in all four patients and no perioperative complications occurred. Conclusion: Management of ureteral calculi in renal transplant recipients is challenging. A multimodal approach involving antegrade and retrograde endoscopic techniques may be required to achieve full stone clearance.