Ileal conduit vs. orthotopic ileal neobladder after radical cystectomy: Systematic review and meta-analysis of long-term renal function.

Radical cystectomy (RC) with urinary diversion is the gold-standard treatment for muscle-invasive and BCG-resistant non-muscle-invasive bladder cancer. The 2 most common diversion techniques are the incontinent ileal conduit (IC) and the continent orthotopic neobladder (NB). Long-term deterioration of renal function after RC is a significant concern, as it is associated with adverse cardiovascular outcomes and increased mortality. We conducted a PRISMA-compliant systematic review and meta-analysis. A comprehensive search across databases till September 2025 was performed. We included studies of adults undergoing RC for bladder cancer with IC vs. NB, provided they reported long-term renal outcomes (e.g., change in estimated glomerular filtration rate [eGFR], incidence of end-stage renal disease [ESRD], significant GFR decline) or perioperative outcomes (e.g., operative time and hospital stay). Fourteen retrospective cohort studies met the inclusion criteria . Long-term renal outcomes were comparable between the NB and IC groups. There were no significant differences in mean change in eGFR (MD -2.48 mL/min/1.73 m², P = 0.28), incidence of ESRD (RR 0.63, P = 0.33), or the risk of a clinically significant decline in GFR (RR 0.78, P = 0.10). However, NB was associated with a significantly higher risk of uretero-intestinal stricture compared to IC (RR 2.58, P = 0.01). Neobladder creation also required a longer operative time (MD 80.11 minutes, P < 0.00001). This meta-analysis suggests that IC and neobladder diversion provide comparable long-term renal outcomes, including GFR decline and ESRD risk. However, neobladder reconstruction is associated with longer operative time and a higher risk of uretero-intestinal stricture. Diversion choice should therefore be individualized based on patient factors, comorbidities, and the need for close postoperative surveillance. These findings should be interpreted with caution given limited study numbers, heterogeneity, and selection bias, highlighting the need for prospective, standardized studies.