Impact of Surgical Techniques on Anastomotic Stricture in Urinary Diversion: A Systematic Review and Meta-analysis

Benign ureteral-ileal anastomotic stricture (UIAS) is a common complication of urinary diversion (UD). Many surgical techniques have been tested to mitigate its risk; however, an optimal strategy is yet to be established. Objective: In this study, we evaluated the impact of various surgical techniques on UIASs in UD.

In July 2024, we searched MEDLINE, Embase, and Web of Science. Random-effects pairwise meta-analyses of risk ratios (RRs) were performed to compare the risk of UIAS between various surgical techniques. The risk of bias was assessed using RoB2, ROBINS-I tools, and Newcastle-Ottawa Scale. (PROSPERO: CRD42024574087).

A total of 46 studies (N = 11 732 patients) were included in meta-analysis. Robotic surgery was significantly associated with a higher risk of UIAS compared with open surgery (RR: 1.47; 95% confidence interval [CI]: 1.24-1.76; p < 0.001). Intracorporeal UD (ICUD) was significantly associated with an increased risk of UIAS compared with extracorporeal UD (ECUD; RR: 1.34; 95% CI: 1.05-1.72; p = 0.020); however, in an analysis limited to robotic surgery, no significant difference was observed between ICUD and ECUD (RR: 1.06; 95% CI: 0.73-1.54; p = 0.7). No significant differences were observed using Wallace versus Bricker technique (RR: 0.68; 95% CI: 0.40-1.18; p = 0.17), Indocyanine green dye (RR: 0.44; 95% CI: 0.12-1.56; p = 0.2), stent-free approach (RR: 0.60; 95% CI: 0.30-1.21; p = 0.15), or single versus double J stents (RR: 0.93; 95% CI: 0.41-2.10; p = 0.9).

The risk of UIAS is significantly higher in the robotic surgery approach, which should prompt more cautious follow-up. Moreover, it was significantly higher in patients with ECUD, while the commonly used UD methods were not significantly associated with the risk of UIAS. Further prospective studies are needed to validate these findings.