Ileum vs Colon for Neobladder Reconstruction After Radical Cystectomy: A Systematic Review and Meta-Analysis

This study aimed to compare and evaluate the functional outcomes and safety of ileal neobladder and colonic neobladder (sigmoid and ileocecal subtypes) after radical cystectomy.

A systematic literature search was conducted across PubMed, Web of Science, and Embase following the PRISMA 2020 guidelines. Subgroup analyses compared ileal neobladder with sigmoid neobladder and ileocecal neobladder. Study quality was evaluated using the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and evidence certainty was evaluated using the GRADE approach. Continuous and dichotomous variables were analyzed using weighted mean differences and risk ratios with 95% confidence intervals.

Seventeen studies (one randomized controlled trial and 16 cohort studies) were included. Early postoperative complications were significantly less frequent with ileal neobladder than with sigmoid neobladder, with no significant difference between ileal and ileocecal neobladders. Late complications and daytime continence were comparable among all groups. Ileal neobladder achieved significantly superior nighttime continence compared with colonic neobladders. However, ileal neobladder was associated with higher postvoid residual urine volume and higher clean intermittent catheterization rates than sigmoid neobladder, with similar voiding outcomes between ileal and ileocecal neobladders.

Ileal neobladder provides superior nighttime urinary continence and lower early complication rates compared with sigmoid neobladder, whereas sigmoid neobladder provides better spontaneous voiding performance. Given the observational nature of available evidence and notable heterogeneity, no single pouch type is universally superior, and individualized surgical selection is recommended.