The best approach of the bladder cuff (i.e., transvesical, extravesical, endoscopic) during radical nephroureterectomy (RNU) remains an unsolved question. The aim of this review is to compare the oncological and perioperative outcomes among three different approaches of the distal ureter during RNU.
A literature search was conducted through June 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The primary outcome was bladder recurrence-free survival and secondary outcomes included: perioperative outcomes, metastasis-free survival, and cancer-specific survival.
A total of 19 non-randomized studies comprising 6581 patients met our inclusion criteria. The risk of bladder recurrence, metastasis and cancer-related death did not differ significantly between each approach (all P>0.05). In subgroup analysis excluding patients with history of bladder cancer, the risk of bladder recurrence remained similar between each approach (all P>0.05). There was no significant difference in terms of operative time, estimated blood loss, length of hospital stay, and postoperative complications between each approach (all P>0.05). The main limitation is the retrospective design of 18/19 included studies.
The present systematic review and meta-analysis highlights the lack of high-level evidence on distal ureter management during RNU. On the basis of the available data, the present review supports the equivalence of different techniques of bladder cuff excision during RNU. The extravesical approach seems non-inferior to the transvesical approach in terms of oncological and perioperative outcomes.
Minerva urology and nephrology. 2023 Dec [Epub]
Andrea Gallioli, Michael Baboudjian, Pietro Diana, Marco Moschini, Evanguelos Xylinas, Francesco Del Giudice, Ekaterina Laukhtina, Francesco Soria, Andrea Mari, José D Subiela, Mathieu Rouy, Angelo Territo, Giuseppe Basile, Joan Palou, Benjamin Pradere, Alberto Breda, EAU Young Academic Urologists Urothelial Cancer Working Group
Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain., Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy., Department of Urology, Bichat-Claude Bernard Hospital Paris Descartes University, Paris, France., Department of Maternal Infant and Urologic Sciences, Sapienza University, Umberto I Polyclinic Hospital, Rome, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Surgical Sciences, University of Turin, Città della Salute e della Scienza, Turin, Italy., Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Hospital Universitario Ramon y Cajal, Madrid, Spain., Aix-Marseille University, Marseille, France., Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain - ., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France.