Robotic radical cystectomy with orthotopic neobladder reconstruction: Techniques and functional outcomes in male patients

Alberto Martini, Ugo Giovanni Falagario, Antonio Russo, Laura S Mertens, Luca Di Gianfrancesco, Carlo Andrea Bravi, Muhammad Abdeen, Mikolaj Mendrek, Eirik Kjøbli, Stephan Buse, Carl Wijburg, Guillaume Ploussard, Alessandro Antonelli, Laura Schwenk, Jan Ebbing, Nikhil Vasdev, Gabriel Froelicher, Hubert John, Abdullah Erdem Canda, Mevlana Derya BalbayMarcel Stoll, Sebastian Edeling, Sami-Ramzi Leyh-Bannurah, Stefan Siemer, Michael Stoeckle, Alexander Mottrie, Frederiek D'Hondt, Alessandro Crestani, Angelo Porreca, Heindrick van der Poel, Karel Dacaestecker, Richard Gaston, Peter Wiklund, Abolfazl Hosseini

Research output: Contribution to journalArticlepeer-review

Abstract

Bladder cancer (BC) is the 7th most diagnosed cancer in males with an age standardized incidence of 20 new cases per 100.000 every year in Europe (1). BC has a high mortality rate and it has been shown that up to 85% of patients with muscle invasive bladder cancer (MIBC) would succumb to the disease within 5 years of diagnosis if MIBC is left untreated(2). The European Association of Urology Guidelines recommend radical cystoprostatectomy (RC) with or without peri-operative chemotherapy in patients with MIBC and selected cases of high risk non-MIBC(1). Even if RC represents a potentially curative approach, it is hampered by high rates of perioperative morbidity(3, 4); additionally, it has a profound impact on postoperative sexual function and urinary continence, in case of orthotopic neobladder reconstruction (5). After the first description of robotic assisted radical cystectomy (RARC) in 2003 (6), there has been a steady increase in the use of RARC in an effort to reduce perioperative complications and improve functional outcomes. In fact, RARC combines the benefits of a minimal invasive approach with the improved vision and precision of a robotic surgical
platform (7). With the increase in cumulative surgical experience, we have witnessed several refinements in the surgical technique, moving from extracorporeal to a complete intracorporeal technique for urinary diversion (8).
The recent publication of the first multicenter randomized control trial (RCT)
comparing robot-assisted radical cystectomy with intracorporeal reconstruction to open radical cystectomy showed a moderate but statistically significant increase in the number of days alive and out of the hospital within 90 days of surgery, providing level 1 evidence in support of RARC with intracorporeal urinary diversion over open RC(9).
While techniques aimed at improving patient’s functional outcomes after RARC have been described (10, 11), there is paucity of data regarding postoperative urinary continence and erectile function in patients who underwent RARC along with neobladder reconstruction and such data is usually derived from relatively small single-center series. With that in mind, we conducted a multi-center study in an effort to evaluate erectile function and urinary continence in male patients undergoing RARC with neobladder reconstruction and to describe surgical techniques which might improve functional outcomes following RARC.
Original languageEnglish
JournalEuropean Urology
Publication statusSubmitted - 30 Sep 2022

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