V12-07 SEX-SPARING ROBOT ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER IN FEMALE: SURGICAL TECHNIQUE, PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES

Abstract

You have accessJournal of UrologyBladder Cancer & Urinary Diversion (V12)1 Apr 2020V12-07 SEX-SPARING ROBOT ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL PADUA ILEAL NEOBLADDER IN FEMALE: SURGICAL TECHNIQUE, PERIOPERATIVE, ONCOLOGIC AND FUNCTIONAL OUTCOMES Gabriele Tuderti*, Riccardo Mastroianni, Rocco Simone Flammia, Mariaconsiglia Ferriero, Costantino Leonardo, Umberto Anceschi, Aldo Brassetti, Salvatore Guaglianone, Michele Gallucci, and Giuseppe Simone Gabriele Tuderti*Gabriele Tuderti* More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000957.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the widespread use of robot assisted radical cystectomy (RARC), there is paucity of data concerning outcomes of sex-sparing (SS) RARC with intracorporeal ileal neobladder (iN) in female patients. In this video we described surgical steps of SS- RARC in female patients, and we reported perioperative, pathologic and functional outcomes. METHODS: From January 2013 to June 2018, 11 female patients underwent sex-RARC-iN at a single tertiary referral centre. Inclusion criteria were cT≤2 N0 M0 bladder tumour at baseline imaging (CT or MRI), and absence of tumour in bladder neck, trigone and urethra at TURB. Exclusion criteria included any contraindication to iN. Key surgical steps are: isolation of the ureters; preparation of umbilical, uterine and superior vesical arteries. In Sex-sparing approach development of vesico-uterine plane is performed, and uterine feeding arteries are preserved, while in standard procedure uterine and vesical pedicle are transected close to their origins from iliac internal artery. Notably, sex-sparing RARC allows to preserve utero-vaginal component of hypogastric plexus that is almost sacrificed during standard RARC. Baseline, perioperative and 1-yr outcomes were reported. RESULTS: Median operative time was 255 minutes. Median hospital stay was 7 days. Low grade Clavien complications occurred in 4 patients (36.3%), while high grade complications were not observed. Seven patients (63.7%) had an organ confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any case. At a median follow-up of 28 months, no patient developed new onset of chronic kidney disease stage 3b; one patient developed ureteroileal anastomotic stricture requiring robotic reimplantation 18 months following surgery. One-yr day-time and night-time continence rates were 90.9% and 86.4%, respectively. Quality of life, physical and emotional functioning improved significantly over time (all p≤0.04), while urinary symptoms and sexual function worsened at 3-mo with a significant recovery at 1-yr (all p≤0.04). Overall, 8 out 11 patients (72.7%) were sexually active at 12-mo evaluation. CONCLUSIONS: In select populations, SS-RARC with iN can be offered to female patients motivated to preserve sexual function as an oncologically safe procedure, associated with favourable functional outcomes. The anatomical preservation of utero-vaginal components of inferior hypogastric plexus represents the cornerstone for a quick and effective recovery in terms of urinary continence and sexual activity. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1112-e1112 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gabriele Tuderti* More articles by this author Riccardo Mastroianni More articles by this author Rocco Simone Flammia More articles by this author Mariaconsiglia Ferriero More articles by this author Costantino Leonardo More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Salvatore Guaglianone More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...