Complications Associated with Ileal Conduit: A Narrative Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, congrats on the worked you’ve done. The paper it’s easy to read and my be interesting for a young resident to start picturing the possible scenarios after RC. The paper it’s nothing new, but it’s not presented as a “revolution” on this field. I only have 2 comments, listed below.

 

“A serum creatinine level greater than 1.69 mg/dL is considered a significant risk factor”: is this in guidelines? Is this cut-off present in both studies cited? Are those studies prospective or randomized? What are the population size of these studies? If these studies are not significant I would not have stressed this cut-off. Consider to remove it or comment here

 

Intraoperative complication section should be stressed a little bit more

Author Response

Reviewer N1

Dear authors, congrats on the worked you’ve done. The paper it’s easy to read and my be interesting for a young resident to start picturing the possible scenarios after RC. The paper it’s nothing new, but it’s not presented as a “revolution” on this field. I only have 2 comments, listed below.

“A serum creatinine level greater than 1.69 mg/dL is considered a significant risk factor”: is this in guidelines? Is this cut-off present in both studies cited? Are those studies prospective or randomized? What are the population size of these studies? If these studies are not significant I would not have stressed this cut-off. Consider to remove it or comment here

We appreciate your time and effort to review this publication. 

We also appreciate your comment regarding the serum creatinine cut-off. After reviewing the cited studies, we agree that this cut-off may not be sufficiently supported. As suggested, we have removed the sentence referencing the 1.69 mg/dL threshold.

The intraoperative complication section should be stressed a little bit more

Thank you for this valuable suggestion. In response, we have revised and expanded the section, now titled 'Intraoperative Considerations' (lines 231–242), to better highlight relevant surgical risks.

 

 

 

Reviewer 2 Report

Comments and Suggestions for Authors

I have reviewed the study titled ''A Narrative Review on Complications Associated with Ileal Conduit Surgery.'' The present article is a narrative review discussing complications of IC urinary diversion after radical cystectomy. 

1. The review claims to be narrative but doesn't sufficiently justify why a systematic approach wasn't used. This omission significantly affects reproducibility. For this reason, it resembles a book chapter rather than a compilation.

2. The study's conclusions do not add any new ideas or foresights; they are merely repetitions of the known. 

Comments on the Quality of English Language

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Author Response

Reviewer N2

Comments and Suggestions for Authors

I have reviewed the study titled ''A Narrative Review on Complications Associated with Ileal Conduit Surgery.'' The present article is a narrative review discussing complications of IC urinary diversion after radical cystectomy. 

We appreciate the time and effort you have taken to review this publication. 

1. The review claims to be narrative but doesn't sufficiently justify why a systematic approach wasn't used. This omission significantly affects reproducibility. For this reason, it resembles a book chapter rather than a compilation.

We appreciate your comment and the feedback. We aimed to provide a broad and practical overview of complications following ileal conduit urinary diversion, rather than to address a specific research question. From the beginning of the study, we felt that a narrative review was the most appropriate format to synthesize diverse sources and present the topic within a clinically valuable context

2. The study's conclusions do not add any new ideas or foresights; they are merely repetitions of the known. 

We agree and have revised the Conclusion (lines 534–539) to include key knowledge gaps and suggestions for future research

 

Reviewer 3 Report

Comments and Suggestions for Authors

Considering that the morbidity associated with IC, especially when compared to continent diversions, remains a subject of debate, this review is interesting and current; in this manuscript, the authors highlight also the management strategies, in case of complications of ileal conduit, in order to enhance clinical practice and improve patient outcomes. The methodology is adequate and the linguistic style is suitqble for publication. The topic is original and relevant, representing a valuable aid in the management of ileal conduit complications. To make the manuscript more complete, the authors should probably explain the advantages of the ileal conduit compared to other urinary diversions. The conclusions are consistent with the evidence and arguments presented. The bibliography is appropriate, and the figure is easy to understand.

Author Response

Reviewer N3

Comments and Suggestions for Authors

Considering that the morbidity associated with IC, especially when compared to continent diversions, remains a subject of debate, this review is interesting and current; in this manuscript, the authors highlight also the management strategies, in case of complications of ileal conduit, in order to enhance clinical practice and improve patient outcomes. The methodology is adequate and the linguistic style is suitqble for publication. The topic is original and relevant, representing a valuable aid in the management of ileal conduit complications. To make the manuscript more complete, the authors should probably explain the advantages of the ileal conduit compared to other urinary diversions. The conclusions are consistent with the evidence and arguments presented. The bibliography is appropriate, and the figure is easy to understand.

We sincerely appreciate your thoughtful and positive feedback on our manuscript.

We agree with your suggestion. In response, we have revised the manuscript to include relevant quality-of-life studies and comparative outcomes between diversion techniques in lines 107–109 and 112–113. These additions address the potential advantages of the ileal conduit. However, we also acknowledge the significant heterogeneity in the existing literature, as noted in line 113.

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I reviewed the study titled "A Narrative Review on Complications Associated with Ileal Conduit Surgery." The presented study is a narrative review, systematically summarizing complications following ileal conduit surgery. However, the literature contains numerous retrospective series, systematic reviews, and meta-analyses. Therefore, I believe the study does not offer a major contribution to the literature and should not be accepted.

Comments on the Quality of English Language

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Author Response

Comments and Suggestions from Author Reviewer 2:

I reviewed the study titled "A Narrative Review on Complications Associated with Ileal Conduit Surgery." The presented study is a narrative review, systematically summarizing complications following ileal conduit surgery. However, the literature contains numerous retrospective series, systematic reviews, and meta-analyses. Therefore, I believe the study does not offer a major contribution to the literature and should not be accepted.

 

Response:

We sincerely thank the reviewer for this comment. We agree that multiple series and reviews exist on outcomes after ileal conduit. Our goal, however, is not to duplicate prior meta-analyses but to provide a practical, clinically oriented synthesis that clinicians can use at the point of care.

Our review adds value by:

• Integrating metabolic, surgical, and stoma-related complications in one document, organized by timing (intra-, short-, intermediate-, long-term) and anatomical site (uretero-ileal, conduit, stoma).

• Emphasizing prevention and management strategies with underlying mechanisms (e.g., metabolic acidosis, ureteral perfusion, mesh for parastomal hernia).

• Incorporating recent advances (through 2024) including ICG assessment, robotic intracorporeal techniques, and prophylactic mesh data.

We have clarified this focus in the Introduction and Discussion to distinguish our contribution from prior statistical reviews and to highlight its educational and practical utility.