Lisette 't Hoen1, Hazel Ecclestone2, Bertil F M Blok1, Gilles Karsenty3, Véronique Phé4,5, Romain Bossier3, Jan Groen1, David Castro-Diaz4,5, Bárbara Padilla Fernández4,5, Giulio Del Popolo6, Stefania Musco6, Jürgen Pannek7, Thomas M Kessler8, Tobias Gross9, Marc P Schneider8, Rizwan Hamid2. 1. Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands. 2. Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, United Kingdom. 3. Department of Urology, Aix Marseille University, Marseille, France. 4. Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris 6 University, Paris, France. 5. Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain. 6. Department of Neuro-Urology, Careggi University Hospital, Florence, Italy. 7. Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland. 8. Neuro-Urology, Spinal Cord Injury Center and Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. 9. Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
Abstract
AIMS: To systematically evaluate effectiveness and safety of bladder augmentation for adult neuro-urological patients. METHODS: The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement was followed for review of publications. The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched until January 2015. No limitations were placed on date or language. Non-original articles, conference abstracts, and publications involving children and animals were excluded. Risk-of-bias and confounder assessment was performed. RESULTS: A total of 20 studies including 511 patients were eligible for inclusion. The level of evidence for the included studies was low, most level 4 studies with only one level 3 study. The data were narratively synthesized. Across all studies high risk-of bias and confounding was found. Primary outcomes were assessed in 16 of the 20 studies and showed improved quality of life and anatomical changes as well as stable renal function. The secondary outcomes were reported in 17 of the 20 studies and urodynamic parameters and continence all demonstrated improvement after bladder reconstruction. Long-term complications continued up to 10 years post-operatively, including bowel dysfunction in 15% of the patients, stone formation in 10%, five bladder perforations and one bladder cancer. CONCLUSIONS: Available studies are not plentiful and of relatively poor quality, appropriately designed prospective studies are urgently needed. Despite this, bladder augmentation appears to be a highly effective procedure at protecting the upper urinary tract and improving quality of life. However, it is associated with relatively high morbidity in both the short and long term.
AIMS: To systematically evaluate effectiveness and safety of bladder augmentation for adult neuro-urological patients. METHODS: The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement was followed for review of publications. The Medline, Embase, and Cochrane controlled trial databases and clinicaltrial.gov were searched until January 2015. No limitations were placed on date or language. Non-original articles, conference abstracts, and publications involving children and animals were excluded. Risk-of-bias and confounder assessment was performed. RESULTS: A total of 20 studies including 511 patients were eligible for inclusion. The level of evidence for the included studies was low, most level 4 studies with only one level 3 study. The data were narratively synthesized. Across all studies high risk-of bias and confounding was found. Primary outcomes were assessed in 16 of the 20 studies and showed improved quality of life and anatomical changes as well as stable renal function. The secondary outcomes were reported in 17 of the 20 studies and urodynamic parameters and continence all demonstrated improvement after bladder reconstruction. Long-term complications continued up to 10 years post-operatively, including bowel dysfunction in 15% of the patients, stone formation in 10%, five bladder perforations and one bladder cancer. CONCLUSIONS: Available studies are not plentiful and of relatively poor quality, appropriately designed prospective studies are urgently needed. Despite this, bladder augmentation appears to be a highly effective procedure at protecting the upper urinary tract and improving quality of life. However, it is associated with relatively high morbidity in both the short and long term.
Authors: Veronika Birkhäuser; Martina D Liechti; Collene E Anderson; Lucas M Bachmann; Sarah Baumann; Michael Baumberger; Lori A Birder; Sander M Botter; Silvan Büeler; Célia D Cruz; Gergely David; Patrick Freund; Susanne Friedl; Oliver Gross; Margret Hund-Georgiadis; Knut Husmann; Xavier Jordan; Miriam Koschorke; Lorenz Leitner; Eugenia Luca; Ulrich Mehnert; Sandra Möhr; Freschta Mohammadzada; Katia Monastyrskaya; Nikolai Pfender; Daniel Pohl; Helen Sadri; Andrea M Sartori; Martin Schubert; Kai Sprengel; Stephanie A Stalder; Jivko Stoyanov; Cornelia Stress; Aurora Tatu; Cécile Tawadros; Stéphanie van der Lely; Jens Wöllner; Veronika Zubler; Armin Curt; Jürgen Pannek; Martin W G Brinkhof; Thomas M Kessler Journal: BMJ Open Date: 2020-08-13 Impact factor: 2.692