| Purpose:Patients with radical cystectomy and urinary diversion can relieve from bladder cancer,as well as are at risk of urethral recurrence.A series of studies have figured out various risk factors leading to urethral recurrence,nevertheless,there are not publication weighing the predictive values of them.Furthermore,the follow-up protocols containing periods and methods,which are also closely associated with urethral recurrence,haven't also been completely established yet.Consequently,we design the meta-analysis to evaluate the incidence of urethral recurrence,meanwhile weigh the predictive values of different risk factors involved in urethral recurrence.Besides,the present meta-analysis concurrently summarizes the follow-up protocols and treatments of patients with urethral recurrence and analyzes their connections to outcomes.Materials and Methods:The studies covering 1971 to 2016 were searched in PubMed,EMBASE and MEDLINE.The meta-analysis was on account of 25 studies which conform to inclusive criteria.STATA software(Version 12.0)was employed to estimate the pooled risk ratio.We assess inter-study heterogeneity via the Cochran's?~2-based Q test and the I-squared test.Results:25 publications including 9498 patients in total are eligible in this analysis ultimately.23 of them reported participant's gender and 20provided age of patients.The average age is 62.3 years(range from 27 to89).Follow-up time is described in 17 studies with a mean of 50.5 months(range from 1 to 254).Patients with concomitant carcinoma in situ are at higher risk of urethral recurrence than those of absent carcinoma in situ.Patients with superficial bladder cancer have a greater possibility to urethral recurrence,and intravesical bladder cancer patients had a possibility higher than those with extracystic bladder cancer.Patients with OCD during radical cystectomy have a higher possibility of urethral recurrence compared to those with CSD.Men of bladder cancer are easier to suffer from urethral recurrence than women.Prostatic involvement and positive urethral margin are both increase the risk of urethral recurrence.Patients with bladder neck involvement obtain higher risks of urethral recurrence than those without bladder neck involvement.Patients with multifocal bladder cancer have a higher possibility of urethral recurrence those with solitary bladder cancer.Among all 25 studies in this literatures analysis,118(60.2%)cases in 9 studies were indicated through routine follow-up,there are another 82(40.8%)patients in 11 studies perceived by symptomatic abnormalities.Urethral cytology is the most common method,and the prognoses are more adverse in patients with symptomatic recurrence.There are 272 cases in 14 publications reported the treatments after UR,190(69.9%)of whom were carried out urethrectomy,52(19.1%)patients with urethra-sparing treatment including chemotherapy,radiation and Bacillus Calmette-Guerin.In addition,12 studies obtaining 180 cases described the outcomes after UR,41(22.8%)patients were still alive until the end of follow-up,and 65(36.1%)patients died of bladder cancer.Conclusion:Urethral recurrence in patients with bladder cancer after RC combined with urethral reroute seriously affects the survival of patients.Reasonable preventive measures,systematic follow-up plan and effective treatment are the keys to reduce the recurrence rate,improve the quality of life and prolong the survival period.For patients with bladder cancer with high recurrent risks,follow-up should be strengthened and stricter follow-up plan should be adopted to achieve early diagnosis and treatment. |
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