Supplementary Material for: The Role of Mechanical Bowel Preparation before Ileal Urinary Diversion: A Systematic Review and Meta-Analysis

Background: Although the use of mechanical bowel preparation (MBP) is still widely promoted as the dogma before patients undergo ileal urinary diversion, an increasing number of clinical trials have suggested that there is no benefit. Thus, we performed a meta-analysis to evaluate the efficacy of MBP in ileal urinary diversion surgery. Methods: A literature search was performed in electronic databases, including PubMed, Embase, Science Citation Index Expanded as well as the Cochrane Library and the Cochrane Clinical Trials Registry, from 1966 to January 1, 2013. Clinical trials comparing outcomes of MBP versus no MBP for ileal urinary diversion surgery were included in the meta-analysis. Pooled odds ratios with 95% confidence intervals were calculated using the fixed- or random-effects models. Results: In total, two randomized controlled trials and five cohort studies were included in this meta-analysis. The primary outcomes, such as bowel leak and bowel obstruction, showed no statistical difference between the two groups. Additionally, the overall mortality rate and death rate related to operation also manifested that MBP does not offer an advantage over the no MBP. Conclusion: This meta-analysis suggests that MBP does not reduce the incidence of perioperative complications in urinary diversion compared with no MBP. However, large randomized controlled clinical trials are needed to confirm this finding.

背景：尽管机械肠道准备（mechanical bowel preparation, MBP）在患者接受回肠尿路改道（ileal urinary diversion）手术前仍被广泛推广为标准诊疗常规，但越来越多的临床试验表明其并无临床获益。为此，本研究开展一项荟萃分析，以评估MBP在回肠尿路改道手术中的临床疗效。
方法：本研究检索了1966年至2013年1月1日期间PubMed、Embase、科学引文索引扩展版（Science Citation Index Expanded）、Cochrane图书馆及Cochrane临床试验注册库等电子数据库。纳入所有对比回肠尿路改道手术中MBP与无肠道准备组患者结局指标的临床试验，开展本次荟萃分析。采用固定效应模型或随机效应模型计算合并比值比（odds ratios）及其95%置信区间（confidence intervals）。
结果：本荟萃分析共纳入2项随机对照试验（randomized controlled trials）与5项队列研究（cohort studies）。肠道漏、肠梗阻等主要结局指标在两组间均无统计学差异。此外，总死亡率及手术相关死亡率也证实，MBP并不优于无肠道准备组。
结论：本荟萃分析显示，与无肠道准备相比，MBP并未降低尿路改道手术患者的围手术期并发症发生率。但仍需开展大规模随机对照临床试验以验证该研究结论。