Postoperative Urinary Complications in Minimally Invasive vs. Abdominal Radical Hysterectomy: A Meta-Analysis with a Focus on Ureterovaginal Fistula

Objective: This study aims to perform a systematic review and meta-analysis to compare the incidence of specific postoperative urologic complications, such as vesicovaginal fistula and ureterovaginal fistula, in patients undergoing minimally invasive radical hysterectomy (MIRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer.

Data sources: A comprehensive literature search was conducted in PubMed, the Cochrane Library, Web of Science, ScienceDirect, and Google Scholar up to April 2024.

Method: Comparative studies evaluating postoperative urologic complications following MIRH and ARH were included. Meta-analyses were conducted using fixed- and random-effects models, with subgroup analyses based on publication year, study quality, BMI, and geographical region.

Tabulation, integration, and results: The meta-analysis included 35 studies. Overall, MIRH (N=17,957) was associated with a significantly higher odds ratio (OR) of 3.189 (95% CI: 2.637-3.856, p < 0.001) for postoperative urologic complications compared to ARH (N=31,878). Ureterovaginal fistula was the most frequently reported complication, with an OR of 4.440 (95% CI: 3.398-5.804, p < 0.001). Subgroup analysis showed a higher OR for studies published between 2016-2024 (OR: 3.637, 95% CI: 2.965-4.462, p < 0.001) and in low-quality studies (OR: 3.981, 95% CI: 3.237-4.897, p < 0.001).

Conclusion: MIRH is associated with a higher incidence of postoperative urologic complications compared to ARH, particularly ureterovaginal fistula. These findings underscore the importance of careful patient selection and the potential need for improved surgical techniques or training to reduce these risks. (CRD42024553756).