Cystectomy and Ileal Conduit for Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review of Outcomes for Different Surgical Approaches.

OBJECTIVE

To assess the outcomes of cystectomy and ileal conduit for managing neurogenic lower urinary tract dysfunction and compare different surgical approaches (open, laparoscopic, and robotic-assisted).

DESIGN, SETTING, AND

PARTICIPANTS

This systematic review was conducted in accordance with PRISMA guidelines, and the protocol was registered in the PROSPERO database (CRD42024512893). A systematic search of MEDLINE/PubMed, Embase, and CENTRAL identified original articles reporting surgical outcomes of cystectomy and ileal conduit in adult neuro-urological patients. Our primary outcome was 30-day high-grade complications. Secondary outcomes included perioperative parameters, late complications, quality of life, and kidney function.

RESULTS AND LIMITATIONS: Ten studies with a high risk of bias were included, comprising 721 patients. Minimally invasive approaches had longer operative times. Mean blood loss was 872 ± 325 mL for open, 376 ± 62 mL for laparoscopic, and 291 ± 29 mL for the robotic-assisted approach. Reported hospital stay durations varied (open: 21 ± 3.3 days; laparoscopic: 17 ± 5.8 days; robotic-assisted: 13 ± 1.9 days). Early complication rates were similar across approaches (15%-20% for high-grade complications). Late high-grade complication rates ranged from 19% to 26%. Studies reported improved post-operative quality of life and generally stable kidney function, though assessment methods varied considerably.

CONCLUSION

Cystectomy with ileal conduit in neurogenic lower urinary tract dysfunction patients is associated with substantial complication rates across all surgical methods. The available evidence is heterogeneous and subject to significant confounding factors. Differences observed between surgical approaches should be interpreted with caution. Prospective comparative studies with standardized reporting are needed to determine the optimal surgical approach for this specific patient population.