Abstract：
OBJECTIVE: To determine and summarize the available data on urinary, sexual, and health-related quality-of-life (HRQOL) outcomes after traditional radical cystectomy (RC), reproductive organ-preserving RC (ROPRC) and nerve-sparing RC (NSRC) for bladder cancer (BCa) in female patients.
METHODS: The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches.
RESULTS: Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison.
CONCLUSIONS: Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.
METHODS: The PubMed, SCOPUS and Web of Science databases were searched to identify studies reporting functional outcomes in female patients undergoing RC and urinary diversion for the treatment of BCa. The outcomes of interest were voiding function (for orthotopic neobladder [ONB]), sexual function and HRQOL. The following independent variables were derived and included in the meta-analysis: pooled rate of daytime and nighttime continence/incontinence, and intermittent self-catheterization (ISC) rates. Analyses were performed separately for traditional, organ- and/or nerve-sparing surgical approaches.
RESULTS: Fifty-three studies comprising 2740 female patients (1201 traditional RC and 1539 organ-/nerve-sparing RC, and 264 nerve-sparing-alone RC) were eligible for qualitative synthesis; 44 studies comprising 2418 female patients were included in the quantitative synthesis. In women with ONB diversion, the pooled rates of daytime continence after traditional RC, ROPRC and NSRC were 75.2%, 79.3% and 71.2%, respectively. The pooled rate of nighttime continence after traditional RC was 59.5%; this rate increased to 70.7% and 71.7% in women who underwent ROPRC and NSRC, respectively. The pooled rate of ISC after traditional RC with ONB diversion in female patients was 27.6% and decreased to 20.6% and 16.8% in patients undergoing ROPRC and NSRC, respectively. The use of different definitions and questionnaires in the assessment of postoperative sexual and HRQOL outcomes did not allow a systematic comparison.
CONCLUSIONS: Female organ- and nerve-sparing surgical approaches during RC seem to result in improved voiding function. There is a significant need for well-designed studies exploring sexual and HRQOL outcomes to establish evidence-based management strategies to support a shared decision-making process tailored towards patient expectations and satisfaction. Understanding expected functional, sexual and quality-of-life outcomes is necessary to allow individualized pre- and postoperative counselling and care delivery in female patients planned to undergo RC.
摘要：
目的：根治性膀胱切除术（RC）对泌尿系统有不利影响，性,和生殖系统。减轻术后功能生活质量下降的方法包括保留器官和保留神经的RC变化；然而，关于女性性别特定结局的高质量数据仍然很少.我们的目的是确定和总结有关泌尿的可用数据，性,和健康相关的生活质量(HRQOL)结果，女性膀胱癌（BCa）的生殖器官保留（ROPRC）和神经保留RC（NSRC）。
方法：PubMed，Scopus,搜索和WebofScience数据库以确定报告接受RC和尿路改道治疗BCa的女性患者功能结局的研究。感兴趣的结果是排尿功能(对于原位新膀胱)，性功能,HRQOL。得出以下独立变量并将其纳入荟萃分析：白天和夜间失禁/失禁的合并率以及间歇性自我导管插入（ISC）率。对传统的，保留器官和/或神经的手术方法。
结果：53项研究包括2,740名女性患者（1,201名接受传统治疗；1,539-器官/NS-保留，或264-NS单独RC）符合定性合成的条件；包括2,418名女性患者的44项研究纳入定量合成。在原位新膀胱（ONB）转移的女性中，传统的白天节制后的汇总率，ROPRC和NSRC分别为75.2%，79.3%,71.2%,分别。传统RC后夜间失禁的合并率为59.5％；在接受ROPRC和NSRC的女性中，这一比率分别增加到70.7％和71.7％，分别。女性患者传统RC合并ONB转流后ISC的合并率为27.6%，ROPRC和NSRC降低至20.6%和16.8%，分别。在评估术后性和HRQOL结果时使用不同的定义和问卷无法进行系统比较。
结论：在RC期间女性保留器官和神经的手术入路似乎可以改善排尿功能。非常需要精心设计的研究探索性和HRQOL结果，以建立基于证据的管理策略，以支持针对患者期望和满意度的共享决策过程。理解预期的功能，性,和生活质量的结果是必要的，以便在计划接受RC的女性患者中进行个性化的前后咨询和护理。
方法：PubMed，Scopus,搜索和WebofScience数据库以确定报告接受RC和尿路改道治疗BCa的女性患者功能结局的研究。感兴趣的结果是排尿功能(对于原位新膀胱)，性功能,HRQOL。得出以下独立变量并将其纳入荟萃分析：白天和夜间失禁/失禁的合并率以及间歇性自我导管插入（ISC）率。对传统的，保留器官和/或神经的手术方法。
结果：53项研究包括2,740名女性患者（1,201名接受传统治疗；1,539-器官/NS-保留，或264-NS单独RC）符合定性合成的条件；包括2,418名女性患者的44项研究纳入定量合成。在原位新膀胱（ONB）转移的女性中，传统的白天节制后的汇总率，ROPRC和NSRC分别为75.2%，79.3%,71.2%,分别。传统RC后夜间失禁的合并率为59.5％；在接受ROPRC和NSRC的女性中，这一比率分别增加到70.7％和71.7％，分别。女性患者传统RC合并ONB转流后ISC的合并率为27.6%，ROPRC和NSRC降低至20.6%和16.8%，分别。在评估术后性和HRQOL结果时使用不同的定义和问卷无法进行系统比较。
结论：在RC期间女性保留器官和神经的手术入路似乎可以改善排尿功能。非常需要精心设计的研究探索性和HRQOL结果，以建立基于证据的管理策略，以支持针对患者期望和满意度的共享决策过程。理解预期的功能，性,和生活质量的结果是必要的，以便在计划接受RC的女性患者中进行个性化的前后咨询和护理。
