Writing a Systematic Review

a good start of a PhD-project

Marije Sloff

PhD-student Experimental Urology

Tissue Engineering

Introduction

• Experimental Urology – internship 2009

• Polymer Chemistry – internship 2011 • Targeted Drug Delivery

• Hyaluronan

PhD-project

• “Developing an artificial stoma for urinary diversion in

patients with extensive bladder disease”.

• Patients

• Bladder cancer

•73.000 new patients/2012 in US

•Muscle-invasive tumors

• Congenital malformations

•Spina bifida or bladder exstrophy

•Neurogenic/dyfunctional bladder

Urinary Diversion (1/2)

Urinary Diversion (2/2)

• Urinary Diversion

• Golden standard is Bricker ileal conduit

• Bowel surgery

• Placing Urostomy

Problems

In 28-81% of the cases complications will occur, due to:

• Intestinal surgery (1-5%) • Leakage/rupture of the anastomosis

• Obstruction

• Fistula formation

• Infections

• Unsuitability of tissue • Necrosis

• Stenosis

• Obstruction

• Deformations

Tissue engineering

• Aims to restore or replace diseased, affected or non-

functional tissues.

• In vitro and In vivo

• Synthetic/biological materials

• W/ or w/o cell technology

• Scaffold

• Temporal support

• Promotes tissue regeneration

• Replacement

Artificial Urostomy (1/2)

• Structural protein Collagen

• (slow) Biodegradable Vypro® II

synthetic polymer mesh

• Porcine model

•Conclusion: A tubular construct can be

used for urinary diversion (although

improvement is needed)

Artificial Urostomy (2/2)

• Problems

• Skin contraction

• Immunological reaction

• Tissue regeneration

• Improvement

• Material

• Animal model

•Porcine model

•Predictive value?

Systematic Review

• “What is the current evidence for the efficacy of

tissue-engineered constructs for urinary diversion in

animal models?”

• PICO

Patient: Urinary diversion in animal models

Intervention: Tissue-engineered construct

Comparison: Classical method using GI tissue

Outcome: Survival/ regeneration/ inflammation/

integration/ functionality

Search Strategy (in progress)

Based on Leenaars et al (2012) 45: 24-31.

Inclusion/Exclusion

Used in Systematic Review

Why start a PhD with systematic Review?

• To prevent unneccessary (animal) experimentation

• To collect information about materials/methods/models

• To generate a detailed overview of all relevant literature

• To learn how to make a comprehensive search strategy

Experienced difficulties

• Commercial side of my research

• Unpublished information

• Negative results

• When to stop/continue

• Slow proces

Conclusions

• Benefits and difficulties

• Do the benefits outweigh the difficulties?

• Time and effort

• Useful information

• Extensive overview

• Full-time focus at beginning of a project

• Use for grant application

Acknowledgements

Department of Urology

Prof. Dr. Wout Feitz

Dr. Egbert Oosterwijk

Dr. Paul Geutjes

SYRCLE

Prof. Dr. Merel Ritskes-Hoitinga

Dr. Rob de Vries