Intracorporeal Urinary Diversion versus Extracorporeal Urinary Diversion during Robot-Assisted Radical Cystectomy

Abstract

Abstract Background/Aim: Radical cystectomy (RC) is a fundamental step in the therapeutic plan of nonmuscle and muscle-invasive urinary bladder cancer. Open RC is a surgical procedure with high morbidity and as such robot-assisted RC (RARC) has been established as an efficient alternative. Although in the beginning, the urinary diversion step during RARC was mostly performed extracorporeally nowadays a preference of the intracorporeal approach is yearly increasing. The aim of this review is to compare these two techniques of urinary diversion and depict the latest trends of current research on this field. Materials and Methods: A literature search of MEDLINE database (March 26, 2022) was performed to retrieve the articles published in English that are dated between January 1, 2010 and February 28, 2022. The search strategy included terms: “intracorporeal,” “vs,” “extracorporeal,” “urinary,” “diversion,” “comparison,” “after,” “RARC” and “or”. Results: Intracorporeal urinary diversion (ICUD) is strongly associated with lower perioperative blood loss and blood transfusion needs compared with the extracorporeal urinary diversion (ECUD). ICUD prolongs the operative duration. However, when ICUD is performed by experienced surgeons or in high volume centers, operative duration is comparable for ICUD and ECUD. The two approaches are assessed as equal in respect of postoperative complications. Conclusion: The debate as to whether ICUD must replace ECUD and become the standard of care does not end with this review. Intracorporeal approach in most of the studies seems to be associated with prolonged operative duration, lower transfusion needs, and equal complication rates when compared with ECUD. However, the contradiction of the results and the low quality of the available data demand the conduction of randomized prospective studies comparing ICUD and ECUD in order to offer the best available treatment to the patient.