The following is a summary of “Incidence of ureteroenteric anastomotic strictures after robotic versus open cystectomy in adults,” published in the February 2024 issue of Urology by Sahni et al.

This systematic review aims to comprehensively analyze and synthesize existing evidence comparing the incidence rates of ureteroenteric anastomotic strictures (UAS) following robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in adults undergoing cystectomy. Additionally, the researchers explore the differential stricture rates between Extracorporeal Urinary Diversion (ECUD) and Intracorporeal Urinary Diversion (ICUD).

A comprehensive literature search was conducted to identify studies comparing UAS incidence in RARC versus ORC. A secondary search was performed to identify studies comparing UAS incidence between ECUD and ICUD. The primary outcome assessed was the incidence rate of UAS following RARC versus ORC, and the secondary outcome focused on the UAS incidence in RARC post-ECUD versus ICUD. 

The quality of evidence was evaluated using the GRADE approach, and statistical analyses were conducted using Review Manager v5.4.

Sixteen studies addressing UAS incidence post-RARC were identified. Out of these, 12 studies providing comparative data between RARC and ORC were included for the primary outcome analysis. The findings suggested that RARC might be associated with a higher incidence of UAS (OR: 1.39; 95% CI 1.11-1.75; P< 0.0001). The included studies, comprising both randomized controlled trials (RCTs) and non-randomized studies, exhibited low certainty of evidence.

In the analysis of urinary diversion techniques, ECUD was associated with a lower rate of UAS than ICUD (OR: 0.74; 95% CI 0.56 to 0.98; P= 0.04). Notably, all studies included in this comparison were non-randomized and provided very low certainty of evidence.

This meta-analysis underscores that the incidence of UAS appears to be higher in RARC than in ORC. Furthermore, ECUD may be associated with lower rates of UAS incidence compared to ICUD. However, these conclusions are cautiously drawn, given the varying levels of evidence quality and study design across the included studies.

Source: sciencedirect.com/science/article/abs/pii/S0090429524000232