Meta-analysis Of Efficacy And Safety Of Orthotopic Urinary Diversion With Preserving Male Reproductive Function Based On GRADE Evaluation

Objective:Meta analysis was used to evaluate the efficacy and safety of the orthotopic urinary diversion with preserving male reproductive function in the treatment of bladder cancer,and the GRADE system of evidence quality assessment was used to grade the related outcomes in order to provide help and guidance for clinical treatment.Methods:Online search of foreign language databases(Pubmed,EMBASE,Cochranelibrary)and Chinese databases(CNKI,CBM,Wanfang Database)and manual supplementary search for clinical randomized and non-randomized controlled trials on the orthotopic urinary diversion with preserving male reproductive function.The retrieval time is from January 2000 to March 2020.The literatures that meet the inclusion exclusion criteria are collected and the data are extracted.According to the data type and evaluation purpose,the meta analysis is carried out by using Revman5.3 software,and the evidence quality is graded by GRADE system.Result:Finally,a total of 10 articles were included in this study,including 2 articles of RCT and 8 articles of nRCT,with a total of 650 patients,including the improved group(n=343)and the control group(n=307).The results showed that(1)Literature quality:The overall literature quality was general,with a certain degree of bias.(2)Meta analysis:The curative effect of the orthotopic urinary diversion with preserving male reproductive function was better than that of non-preservation group in improving postoperative erectile function and urine control function,and the difference was statistically significant,but this operation does not show that the effect of tumor recurrence and metastasis,prostate cancer occurrence and survival is better than that of non-preservation group,it was no statistically significant.(3)Publication bias:It can be seen from the funnel plot that postoperative outcome indicators such as erectile function,urinary control function,tumor recurrence and metastasis,prostate cancer occurrence and survival showed asymmetry,with certain publication bias.(4)Sensitivity analysis:The outcome indexes such as erectile function,urine control function,tumor recurrence and metastasis and survival were stable and low sensitivity,while the outcome index of postoperative prostate cancer was not stable and highly sensitive.(5)GRADE outcome:The orthotopic urinary diversion with preserving male reproductive function is low-quality evidence in improving postoperative erection,urine control function and survival,while postoperative tumor recurrence and metastasis and occurrence of prostate cancer are very low-quality evidence,RCT and nRCT studies are inadequate in research design.(6)Safety evaluation:Under the strict screening before operation,the orthotopic urinary diversion with preserving male reproductive function has similar effects in tumor control and prolonging survival time compared with those without preservation.Conclusion:The orthotopic urinary diversion with preserving male reproductive function can effectively improve postoperative erectile function and postoperative urine control function,and there is no significant difference in postoperative survival time compared with non-retained patients;it can not show that there is a difference in the postoperative tumor recurrence and metastasis and the occurrence of prostate cancer between the reserved group and the non-reserved group,but the level of evidence is low,which needs further study.Under the strict screening before operation,the orthotopic urinary diversion with preserving male reproductive function has certain efficacy and safety in the treatment of bladder cancer,which is worthy of further promotion.At present,more related clinical RCT are needed.