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A comparison between limited bowel preparation and comprehensive bowel preparation in radical cystectomy with ileal urinary diversion: a systematic review and meta-analysis of randomized controlled trials

  • Urology - Review
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Abstract

Purpose

Our aim is to evaluate the value of limited bowel preparation (LBP) in radical cystectomy (RC) with ileal urinary diversion (IUD).

Methods

A systematic literature search was conducted on electronic database up to February 2020. All data were analyzed using RevMan5 (version 5.3). A subgroup analysis comparing the efficacy of CBP and no bowel preparation (NBP) was also performed.

Results

Six randomized controlled trials (RCTs) including 743 patients were finally enrolled for statistical analysis. According to the meta-analysis, there was no significant difference between LBP group and comprehensive bowel preparation (CBP) group, concerning operative time (p = 0.79), length of stay (p = 0.46), the time to first toleration of clear liquids (p = 0.95), and overall complications (p = 0.29). However, the time to first bowel activity (SMD: − 0.77, 95% CI − 1.47 to − 0.07, p = 0.03), risk of fever (RR: 0.53, 95% CI 0.33–0.85, p = 0.008), time to first flatus (SMD: − 1.06, 95% CI − 2.02 to − 0.10, p = 0.03), and risk of wound healing disorders (RR: 0.65, 95% CI 0.44–0.95, p = 0.03) were significantly lower in LBP group compared with CBP group. Subgroup analysis showed a significant lower risk of wound healing disorders in favor of NBP (RR: 0.50, 95% CI 0.29–0.87, p = 0.01).

Conclusions

Current evidence indicated that LBP protocols might accelerate recovery of gastrointestinal function, promote wound healing, and reduce the risk of fever without increasing complications in patients undergoing RC with IUD. Besides, bowel preparation also did not hinder wound healing. Further, well-designed RCTs conducted by experienced surgeons are warranted before making the final clinical guidelines.

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Funding

The study was supported by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZY2016104) and Pillar Program from Department of Science and Technology of Sichuan Province (2018SZ0219).

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Author notes

  1. Dechao Feng and Xue Li contributed equally to this work and should be considered as co-first author.

Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, 610041, People’s Republic of China

    Dechao Feng, Shengzhuo Liu, Ping Han & Wuran Wei

  2. Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China

    Xue Li

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  1. Dechao Feng
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Correspondence to Wuran Wei.

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Feng, D., Li, X., Liu, S. et al. A comparison between limited bowel preparation and comprehensive bowel preparation in radical cystectomy with ileal urinary diversion: a systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol 52, 2005–2014 (2020). https://doi.org/10.1007/s11255-020-02516-9

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