Sex-Sparing Robot-Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in Female: Surgical Technique, Perioperative, Oncologic and Functional Outcomes

Abstract

Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14–51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all p ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all p ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.

Functional results of hautmann neobladder with chimney modification and wallace ureteroileal anastomosis: initial experience with 22 patients

“…All these findings together bolster the assertion that meticulous ureteral handling, along with fine suturing technique of Wallace uretero-ileal anastomosis and shorter intestinal chimney, are essential to minimize the risk of postoperative strictures, urinary leakage and VUR. However, studies presenting different techniques of uretero-ileal anastomosis and orthotopic reservoir construction, showed comparable results in regard to early and late postoperative complications rate (18,19).…”

Functional outcomes after robot‐assisted radical cystectomy: A review of literature

“…At 12 months, day and night-time continence rates were 91% and 86%, respectively; however, the exact definition of continence was not specified. 22 In contrast, in a study of 13 female patients with Padua neobladder by Simone et al reported day and night-time continence at 46% and 39%, respectively (utilizing zero pads/day). 23 As part of assessing UF, some studies evaluated the need for ISC after RARC.…”

“…In one study, ISC was required in three out of 11 women who underwent RARC and neobladder. 22 It is still unknown if there are any patient or disease-related factors associated with the need for ISC. Studies examining urodynamics after RARC are scarce.…”

“…The authors attribute their positive functional outcomes to the added dexterity the robot assistance provides when dissecting the inferior hypogastric plexus, which is otherwise difficult to preserve. 22 Dhar et al…”

From Basic Science to Clinical Research to Develop New Solutions to Improve Diagnoses and Treatment of Bladder Cancer Patients

“…Second, functional outcomes after radical cystectomy need to be further reported and investigated to increase the quality of life of BCa patients. Tuderti et al [7] reported their experience of patients treated with sex sparing robot-assisted radical cystectomy in female patients receiving an intracorporeal neobladder reporting good oncological and functional outcomes 12 months after treatment. From the same institution, Claroni et al [8] reported on recovery outcomes from anesthesia after robotic-assisted RC.…”