Intracorporeal Diversion Research Articles

Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

Evaluating the Differences of Wound Related Complications in Robotically Assisted Radical Cystectomy vs Open Radical Cystectomy

ObjectiveTo determine whether robotic assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) compared to open radical cystectomy (ORC) or RARC with extracorporeal urinary diversion (ECUD) would result in a decreased rate of surgical site complications. RARC has been shown to be non-inferior to ORC. Both RARC and ORC are complicated by a high rate of perioperative morbidity, including wound related complications, which may be decreased by a robotic approach with intracorporeal diversion. MethodsA retrospective review of our bladder cancer database for patients undergoing radical cystectomy from 2013 to 2021. Patients were stratified by surgical technique as RARC with ICUD vs. ORC vs. RARC with ECUD. Surgical site complications were measured at both 30 and 90-day intervals. ResultsOf the 269 patients, 127 (47.2%) had RARC with ICUD, 118 (43.7%) had ORC, and 24 (8.9%) had RARC with ECUD (mean ages 71.0, 69.5, 67.5 respectively). A comparison of the three groups demonstrated statistical significance at both the 30-day (p<0.001) and 90-day (p<0.001) timeframes for total surgical site complications, with RARC with ICUD having the fewest amount of patients experience a surgical site complication (0.8%) followed by ORC (25.4%) and RARC with ECUD (29.2%). ConclusionOverall, we observed lower surgical site complication rates among patients undergoing RARC with ICUD compared to patients who underwent ORC or RARC with ECUD. This study suggests that decreased surgical site complications may be one benefit of the minimally invasive approach particularly in patients at high risk for surgical site complications after radical cystectomy.

Minimally Invasive Techniques in Radical Cystectomy: Is It Justified

Summary Over the past two decades there has been a gradual shift towards the use of minimally invasive radical cystectomy in the surgical management of muscle invasive bladder cancer. Though there has been some reluctance in the use of intracorporeal diversion, with advent of robotic technology most high volume centres are performing completely minimally invasive radical cystectomy. Most studies show similar oncological efficiency between minimally invasive techniques and open techniques with lesser complications and hospital stay as well as better quality of life measures. In this chapter we try to compare minimally invasive techniques with open techniques and justify the use of minimally invasive radical cystectomy more so with intracorporeal diversion.

Short-term and long-term outcomes of intracorporeal "V-O manner" ureter-ileal anastomosis in robotic-assisted laparoscopic radical cystectomy with urinary diversion: a retrospective cohort study.

There are several ways to perform ureter-ileal anastomosis (UIA), but there is currently no universally recognized standard approach. Unfortunately, these approaches may increase the risk of urine leakage or stricture. The aim of this study is we to describe an intracorporeal "V-O manner" UIA in robotic-assisted laparoscopic radical cystectomy (RARC) with urinary diversion, and to evaluate the short- and long-term patient outcomes. Between May 2012 and September 2018, 28 patients of bladder urothelial carcinomas (clinical stage T2-4aN0M0) who underwent RARC with intracorporeal urinary diversion (IUD) were included. All the patients received regular postoperative follow-up for 6-76 months. During the procedure of intracorporeal diversion, a "V-O manner" of UIA imitating the pyeloplasty in ureteropelvic junction (UPJ) obstruction was used to perform a mucosa-to-mucosa anastomosis. We observed short-term outcomes (operative time, blood loss, transfusion rate, length of hospital stay, 90-day mortality, and surgical complications) as well as long-term outcomes including kidney function and urinary diversion. Intracorporeal orthotopic ileal neobladder (OIN) was performed in 23 patients whereas intracorporeal ileal conduit (ICD) was performed in 5 patients. The "V-O manner" UIA was applied in all the cases. The average duration of bilateral UIA was about 40 min. The median pelvic lymph node yield was 26 (range, 14-43). All patients ambulated on postoperative 2 to 3 days, and bowel function recovered on postoperative day 3 to 4. The median length of hospital stay was 14 days [interquartile range (IQR), 9-18 days]. A total of 9 patients experienced complications. Postoperative images confirmed satisfying drainage of bilateral ureters without urine leakage or stricture. During the follow up (median 29 months), all participants showed normal renal functions with satisfactory urinary diversion without hydronephrosis. We describe a feasible intracorporeal "V-O manner" UIA in RARC with urinary diversion, which provides improved outcomes in avoiding urine leakage or stricture and preventing the occurrence of hydronephrosis. Larger randomized controlled trials and longer duration of follow-up needs to be required in the future.

MP56-10 COMPLICATIONS AND ONCOLOGIC OUTCOMES AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY: THE ROSWELL PARK COMPREHENSIVE CANCER CENTER EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP56-10 COMPLICATIONS AND ONCOLOGIC OUTCOMES AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY: THE ROSWELL PARK COMPREHENSIVE CANCER CENTER EXPERIENCE Usma Shabir, Jorge Daza, Grace Harrington, Mohammad Khan, Zuha Jaffar, Nicholas Colan, Muhsinah Howlader, Zhe Jing, Qiang Li, Ahmed A. Hussein, and Khurshid A. Guru Usma ShabirUsma Shabir More articles by this author , Jorge DazaJorge Daza More articles by this author , Grace HarringtonGrace Harrington More articles by this author , Mohammad KhanMohammad Khan More articles by this author , Zuha JaffarZuha Jaffar More articles by this author , Nicholas ColanNicholas Colan More articles by this author , Muhsinah HowladerMuhsinah Howlader More articles by this author , Zhe JingZhe Jing More articles by this author , Qiang LiQiang Li More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to report the complications, readmission, and oncologic outcomes for 751 consecutive Robotic Radical Cystectomies (RARCs) done at a single tertiary center. METHODS: Patients who underwent RARC from 2005 to 2022 were identified. Patient’s demographics, complications and oncological outcomes were described. Recurrence-free (RFS), disease specific (DSS) and overall survival (OS) were depicted using the Kaplan Meier method. Logistic and COX regression were used to evaluate variables associated with complications and oncologic outcomes, respectively. RESULTS: 751 consecutive RARCs were included. Median age was 69 years, 74% were males, 79% had intra-corporeal diversion, and 9% received neobladder. Eighty six percent developed complications (43% had high grade complications). pN+, intra-corporeal diversion, neobladder, inpatient and ICU stay were associated with high-grade complications (Table). pT, pN, soft tissue surgical margins, BMI, age and CCI were the main determinants of survival (Table). RFS, DSS and OS were 64%, 74% and 53% at 5 years; 62%, 66% and 34% at 10 years (Figure). CONCLUSIONS: Older age, comorbidity and higher disease stage are associated with survival after RARC. Source of Funding: Roswell Park alliance Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e777 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Usma Shabir More articles by this author Jorge Daza More articles by this author Grace Harrington More articles by this author Mohammad Khan More articles by this author Zuha Jaffar More articles by this author Nicholas Colan More articles by this author Muhsinah Howlader More articles by this author Zhe Jing More articles by this author Qiang Li More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

MP52-18 ROBOT-ASSISTED SUPRATRIGONAL CYSTECTOMY AND AUGMENTATION CYSTOPLASTY FOR NEUROLOGICAL BLADDER IN ADULTS: COMPARISON OF EXTRACORPOREAL VS. INTRACORPOREAL DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP52-18 ROBOT-ASSISTED SUPRATRIGONAL CYSTECTOMY AND AUGMENTATION CYSTOPLASTY FOR NEUROLOGICAL BLADDER IN ADULTS: COMPARISON OF EXTRACORPOREAL VS. INTRACORPOREAL DIVERSION Benoit Peyronnet, Pierre Lecoanet, Juliette Hascoet, Adil Mellouki, Branwell Tibi, Gregory Verhoest, Karim Bensalah, Andrea Manunta, and Imad Bentellis Benoit PeyronnetBenoit Peyronnet More articles by this author , Pierre LecoanetPierre Lecoanet More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Adil MelloukiAdil Mellouki More articles by this author , Branwell TibiBranwell Tibi More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , and Imad BentellisImad Bentellis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is very little data on robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RASCAC) in adult neurological patients. The objective of this study was to compare the perioperative outcomes of RASCAC with extracorporeal (RASCAC-EXTRA) vs. intracorporeal (RASCAC-INTRA) diversion in adults. METHODS: The charts of all patients who underwent a RASCAC for neurogenic lower urinary tract dysfunction (NLUTD) between October 2015 and April 2021 in three centers were retrospectively reviewed. The diversion was done extracorporeally between 2015 and 2019 ù`and intracorporeally thereafter. The preoperative and 3 months postoperative assessments included bladder diaries. urodynamics and the ICIQ-SF. Qualiveen SF and USP questionnaires. The continence status postoperatively was categorized as complete continence (no pad). improved continence or unchanged continence RESULTS: Twenty patients were enrolled over the study period: seven RASCAC-EXTRA and 13 RASCAC-INTRA. Two conversions to an open approach were required in the RASCAC-EXTRA group (28.6% vs. 0%; p=0.04). The operative time was shorter in the RASCAC-INTRA group (306.2 vs. 432.9 min; p=0.006). The length of hospital stay was comparable in both groups (8.3 vs. 8.4 days; p=0.81). The rate of post-operative complications was comparabale in the RASCAC-INTRA and RASCAC-EXTRA groups (61.5% vs. 71.4%; p=0.99). Among these complications. Only three were Clavien ≥3 (15%), two in the RASCAC-INTRA group and one ni the RASCAC-EXTRA group (15.4% vs. 14.3%; p=0.99). The time to oral feeding and time to return of bowel function were significantly shorter in the RASCAC-INTRA group (2.3 vs. 4.1 days; p=0.03 and 2 vs. 4.4 days; p=0.02 respectively). The rates of complete continence at 3 months wer similar in both groups (75% vs. 57.1%; p=0.31). CONCLUSIONS: Robot-assisted supratrigonal cystectomy and augmentation cystoplasty appears to be technically feasible in adult neurological patients. The perioperative outcomes were mostly comparable in the intracorporeal and extracorporeal groups but there was a shorter operative time and shorter times to oral feeding and return of bowel function in the RASCAC-INTRA group. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e709 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benoit Peyronnet More articles by this author Pierre Lecoanet More articles by this author Juliette Hascoet More articles by this author Adil Mellouki More articles by this author Branwell Tibi More articles by this author Gregory Verhoest More articles by this author Karim Bensalah More articles by this author Andrea Manunta More articles by this author Imad Bentellis More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-08 EVALUATION OF FUNCTIONAL OUTCOMES AND QUALITY OF LIFE IN ELDERLY PATIENTS (≥75 Y.O.) UNDERGOING MINIMALLY INVASIVE RADICAL CYSTECTOMY WITH SINGLE STOMA URETEROCUTANEOSTOMY VS. BRICKER INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP65-08 EVALUATION OF FUNCTIONAL OUTCOMES AND QUALITY OF LIFE IN ELDERLY PATIENTS (≥75 Y.O.) UNDERGOING MINIMALLY INVASIVE RADICAL CYSTECTOMY WITH SINGLE STOMA URETEROCUTANEOSTOMY VS. BRICKER INTRACORPOREAL ILEAL CONDUIT URINARY DIVERSION Antonio Luigi Pastore, Yazan AL Salhi, Andrea Fuschi, Alessia Martoccia, Fabio Maria Valenzi, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Silvio Scalzo, Paolo Pietro Suraci, Onofrio Antonio Rera, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan AL SalhiYazan AL Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Silvio ScalzoSilvio Scalzo More articles by this author , Paolo Pietro SuraciPaolo Pietro Suraci More articles by this author , Onofrio Antonio ReraOnofrio Antonio Rera More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged≥75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. METHODS: In this retrospective analysis, we investigated elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel's recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. RESULTS: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. CONCLUSIONS: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications especially in frail patients aged≥75 y.o. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e893 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan AL Salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Fabio Maria Valenzi More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Silvio Scalzo More articles by this author Paolo Pietro Suraci More articles by this author Onofrio Antonio Rera More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

Interview: Timothy Clinton

Interview: Timothy Clinton

Impact of outcomes and costs for implementation of robotic radical cystectomy with full intracorporeal urinary diversion.

Radical cystectomy (RC) remains a surgery with important morbidity despite technical advances. Our aim was to determine the impact on outcomes and costs of robot-assisted radical cystectomy (RARC) with full intracorporeal diversion. We retrospectively included 196 consecutive patients undergone RC for bladder cancer between 2017 and 2022. Comparisons were done between the open radical cystectomy (ORC; n = 166) and RARC with full intracorporeal diversion (n = 30) in the overall cohort and after matched pair analysis. More neobladders were performed in the RARC group (40% vs 18.7%, p = 0.011). Peri-operative parameters continuously improved over time in the RARC cohort despite an increased proportion of elderly patients with higher comorbidity index. RARC patients had lower prolonged stay (33.3% vs 68.3%, p = 0.002), lower grade 1 complication rates (26.7% vs 53.3%, p = 0.016) and blood loss (185 vs 611 ml, p <0.001) than ORC patients. RARC was an independent favorable predictor for prolonged stay (OR 0.199) and complication (OR 0.334). Cost balance favored ORC, with an increase of hospitalization cost at 816 euros for RARC. After matching, RARC with full intracorporeal diversion was associated with improved outcomes and a moderated increase of post-operative costs mainly due to the use of robotic devices.

Higher preoperative eGFR is a predictor of worse renal function decline after robotic assisted radical cystectomy: Implications for postoperative management.

In patients with muscle invasive bladder cancer or high risk noninvasive bladder cancer, renal function decline is a concern after radical cystectomy with urinary diversion. The pathophysiology of this decline is multifactorial, with subclinical acidosis and metabolic derangements from the diversion thought to contribute. It is unknown whether patients with baseline chronic kidney disease (CKD) are at increased risk of further decline in renal function. We performed a retrospective review of two high volume robotic assisted radical cystectomy (RARC) centers between 2016 and 2020. Preoperative demographics and comorbidities were collected. Postoperative estimated glomerular filtration rate (eGFR) was calculated at 12 and 24 months to determine short-term rate in decline of eGFR. Absolute and percent changes in eGFR were calculated. There were a total of 555 patients who underwent RARC. Men comprised 76.2% of the cohort. Neoadjuvant chemotherapy was given in 31% of patients and adjuvant chemotherapy was given in 4.81% of patients. Higher preoperative eGFR (B -0.549, 95% CI -0.708 to -0.391, P < 0.001) and presence of diabetes mellitus (B -15.414, 95% CI -24.820 to -6.008, P = 0.001) were significant predictors of eGFR decline at 12 months. At 24 months, presence of diabetes mellitus (B -11.799, 95% CI -21.816 to -1.782, P = 0.021) and higher preoperative eGFR (B -0.621, 95% CI -0.796 to -0.446, P < 0.001) were correlated with a steeper decline in eGFR. Higher preoperative eGFR was also predictive of upstaging to CKD3 or higher post operatively (OR 1.019, 95% CI 1.004-1.034, P = 0.015). Intracorporeal diversion was protective, whereas presence of hypertension, diabetes mellitus, and higher preoperative eGFR predicted greater decline in eGFR. Patients with higher preoperative eGFR and diabetes are at increased risk of renal function decline post RARC at 12 and 24 months. This suggests that patients with risk factors for renal function decline, but otherwise normal renal function at baseline, are a particularly vulnerable population for progression to CKD after RARC and should be counseled and closely followed postoperatively for renal function deterioration.

MP03-01 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH EXTRACORPOREAL URINARY DIVERSION DOES NOT INCREASE URETEROENTERIC STRICTURE RATE: OUTCOMES FROM A RANDOMIZED TRIAL COMPARING OPEN VERSUS ROBOTIC CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP03-01 ROBOT-ASSISTED RADICAL CYSTECTOMY WITH EXTRACORPOREAL URINARY DIVERSION DOES NOT INCREASE URETEROENTERIC STRICTURE RATE: OUTCOMES FROM A RANDOMIZED TRIAL COMPARING OPEN VERSUS ROBOTIC CYSTECTOMY Chun Huang, Melissa Assel, Benjamin Beech, Nicole Benfante, Daniel Sjoberg, Jonathan Coleman, Guido Dalbagni, Harry Herr, S. Machele Donat, Vincent Laudone, Andrew Vickers, Bernard Bochner, and Alvin Goh Chun HuangChun Huang More articles by this author , Melissa AsselMelissa Assel More articles by this author , Benjamin BeechBenjamin Beech More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Daniel SjobergDaniel Sjoberg More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Guido DalbagniGuido Dalbagni More articles by this author , Harry HerrHarry Herr More articles by this author , S. Machele DonatS. Machele Donat More articles by this author , Vincent LaudoneVincent Laudone More articles by this author , Andrew VickersAndrew Vickers More articles by this author , Bernard BochnerBernard Bochner More articles by this author , and Alvin GohAlvin Goh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002515.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted radical cystectomy is increasingly used to treat bladder cancer. There have been reports of higher stricture risks compared to open cystectomy. We analyzed stricture risk in patients randomized to open or robotic cystectomy with extracorporeal urinary diversion. METHODS: We included 118 patients randomized to robotic (n=60) or open (n=58) cystectomy at a single, high-volume institution. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher’s exact test. RESULTS: Fifty-eight and 60 patients were randomized to robotic and open cystectomy, respectively. We identified 5 strictures, all in the open group. In patients with at least 1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% CI 1.5%, 17%). Of the 5 strictures, 3 were managed endoscopically while 2 required open revision. There was no evidence that perioperative grade 3-5 complication were associated with development of a stricture (p=1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (p=0.15). CONCLUSIONS: In this study at a high volume center, robotic cystectomy with extracorporeal urinary diversion achieved excellent ureteral anastomotic outcomes. Although stricture risk was higher in the open group, risk was low in both arms. Purported increased risk of stricture is not a reason to avoid the robot-assisted radical cystectomy. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed. Source of Funding: This study was supported in part by the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center (MSK), Pin Down Bladder Cancer, the Michael and Zena Wiener Research and Therapeutics Program in Bladder Cancer, and a Cancer Center Support Grant (P30 CA008748) to MSK from the National Institutes of Health/National Cancer Institute © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e19 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chun Huang More articles by this author Melissa Assel More articles by this author Benjamin Beech More articles by this author Nicole Benfante More articles by this author Daniel Sjoberg More articles by this author Jonathan Coleman More articles by this author Guido Dalbagni More articles by this author Harry Herr More articles by this author S. Machele Donat More articles by this author Vincent Laudone More articles by this author Andrew Vickers More articles by this author Bernard Bochner More articles by this author Alvin Goh More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP42-12 HIGHER PREOPERATIVE EGFR IS A PREDICTOR OF WORSE RENAL FUNCTION DECLINE AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP42-12 HIGHER PREOPERATIVE EGFR IS A PREDICTOR OF WORSE RENAL FUNCTION DECLINE AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY Shirin Razdan, Benjamin Eilender, John Pfail, Mariely Garcia, Daniel Ranti, Shoshana Rosenzweig, Abolfazl Hosseini, Jari Radros, Reza Mehrazin, Peter Wiklund, and John Sfakianos Shirin RazdanShirin Razdan More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , John PfailJohn Pfail More articles by this author , Mariely GarciaMariely Garcia More articles by this author , Daniel RantiDaniel Ranti More articles by this author , Shoshana RosenzweigShoshana Rosenzweig More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Jari RadrosJari Radros More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Peter WiklundPeter Wiklund More articles by this author , and John SfakianosJohn Sfakianos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002608.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with muscle invasive bladder cancer or high risk noninvasive bladder cancer, renal function decline is a concern after radical cystectomy with urinary diversion. The pathophysiology of this decline is multifactorial, with subclinical acidosis and metabolic derangements from the diversion thought to contribute. It is unknown whether patients with baseline chronic kidney disease (CKD) are at increased risk of further decline in renal function. METHODS: We performed a retrospective review of two high volume robotic assisted radical cystectomy (RARC) centers between 2016-2020. Preoperative demographics and comorbidities were collected. Postoperative estimated glomerular filtration rate (eGFR) was calculated at 12 and 24 months to determine short-term rate in decline of eGFR. Absolute and percent changes in eGFR were calculated. RESULTS: There were a total of 555 patients who underwent RARC. Men comprised 76.2% of the cohort. Neoadjuvant chemotherapy was given in 31% of patients and adjuvant chemotherapy was given in 4.81% of patients. Higher preoperative eGFR (B -0.549, 95% CI -0.708 - -0.391, p<0.001) and presence of diabetes mellitus (B -15.414, 95% CI -24.820- -6.008, p=0.001) were significant predictors of eGFR decline at 12 months. At 24 months, presence of diabetes mellitus (B -11.799, 95% CI -21.816 - -1.782, p=0.021) and higher preoperative eGFR (B -0.621, 95% CI -0.796 - -0.446, p<0.001) were correlated with a steeper decline in eGFR. Higher preoperative eGFR was also predictive of upstaging to CKD3 or higher post operatively (OR 1.019, 95% CI 1.004-1.034, p=0.015). Intracorporeal diversion was protective, whereas presence of hypertension, diabetes mellitus, and higher preoperative eGFR predicted greater decline in eGFR. CONCLUSIONS: Patients with higher preoperative eGFR and diabetes are at increased risk of renal function decline post RARC at 12 and 24 months. This suggests that patients with risk factors for renal function decline, but otherwise normal renal function at baseline, are a particularly vulnerable population for progression to CKD after RARC and should be counseled and closely followed postoperatively for renal function deterioration. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e735 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Benjamin Eilender More articles by this author John Pfail More articles by this author Mariely Garcia More articles by this author Daniel Ranti More articles by this author Shoshana Rosenzweig More articles by this author Abolfazl Hosseini More articles by this author Jari Radros More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author John Sfakianos More articles by this author Expand All Advertisement PDF DownloadLoading ...

Predictive Factors of Early Postoperative Complications After Robot-Assisted Radical Cystectomy for Urothelial Bladder Carcinoma.

Purpose: To identify protective and risk factors of early postoperative complications after robot-assisted radical cystectomy (RARC) for urothelial bladder carcinoma. Methods: Data of all robot-assisted cystectomies performed in six French centers between February 2010 and December 2019 were retrospectively reviewed. All RARCs for bladder cancer (muscle-invasive and high-risk or Bacillus Calmette-Guerin-resistant nonmuscle-invasive bladder cancer) were included. Perioperative outcomes and early postoperative complications (in the first 30 days) were collected. Multivariable analysis was performed to identify factors associated with early postoperative complications. Results: Two hundred seventy patients were included. The overall incidence of early postoperative complications after RARC was 52.2% (27% of major complications). Most frequent complications were infectious complications (24.4%) and paralytic ileus (15.6%). Anticoagulant therapy (odds ratio [OR] = 2.909, 95% confidence interval [CI]: 1.003-8.432) and ureteroenteric anastomosis-type Wallace II (OR = 4.4, 95% CI: 1.435-13.489) were associated with a higher rate of overall complications. Complete intracorporeal diversion was a protective factor (OR = 0.399, 95% CI: 0.222-0.718). Tobacco consumption, anticoagulant therapy, and ureteroenteric anastomosis-type Wallace II were associated with a higher rate of minor complications (OR = 2.01, 95% CI: 1.079-3.744; OR = 2.495, 95% CI: 1.022-6.089; OR = 3.836, 95% CI: 1.384-10.63, respectively). Opioid-free analgesia (OFA) was associated with a lower rate of infectious complications (OR = 0.148, 95% CI: 0.034-0.644). Conclusion: Early postoperative complication rate after RARC for urothelial bladder carcinoma is high. Encouraging complete intracorporeal diversion and promoting OFA seem to reduce postoperative complications in the first 30 days. Prospective studies are needed to provide a high level of evidence.

V40 - Robotic management of surgical complications after robot-assisted radical cystectomy with intracorporeal diversion

V40 - Robotic management of surgical complications after robot-assisted radical cystectomy with intracorporeal diversion

A0711 - Robot-assisted supratrigonal cystectomy and augmentation cystoplasty for neurological bladder in adults: Comparison of extracorporeal vs. intracorporeal diversion

A0711 - Robot-assisted supratrigonal cystectomy and augmentation cystoplasty for neurological bladder in adults: Comparison of extracorporeal vs. intracorporeal diversion

Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion.

Background: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged > 75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. Methods: We conducted a retrospective analysis of elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel’s recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. Results: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications.

Ileal conduit versus neobladder: A propensity score-matched analysis of the effect on renal function.

To analyze the long-term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion. We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal conduit patients were matched in a 1:2 ratio and a propensity score-matched analysis was carried out. Data were summarized using descriptive analysis. Trend plots were generated using baseline and follow-up creatinine values to compare estimated glomerular filtration rate at 3 months, then annually for 5 years. Variables associated with estimated glomerular filtration rate were assessed using multivariate linear analysis. Our cohort consisted of 137 patients (neobladder n = 50 and ileal conduit n = 87) with a median follow-up time of 3 years (interquartile range 1-7 years). The ileal conduit group had shorter operative times (352 vs 444 min, P < 0.01), intracorporeal diversions were more common (66% vs 44%, P = 0.01), had prior abdominal surgery (66% vs 38%, P < 0.01) and had radiation (9% vs 0%, P = 0.03). The neobladder group more commonly had recurrent urinary tract infections (22% vs 3%, P < 0.01) and a steeper decrease in estimated glomerular filtration rate in the first year. On multivariate linear analysis, age/year (-0.59), body mass index per kg/m2 (-0.52), preoperative estimated glomerular filtration rate per unit (0.51), recurrent urinary tract infections (-14.03) and time versus day 90 (year 1, -7.52; year 2, -9.06; year 3, -10.78) were significantly associated with estimated glomerular filtration rate. Ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot-assisted radical cystectomy. Recurrent urinary tract infections were associated with a worse estimated glomerular filtration rate.

Orthotopic urinary diversions after radical cystectomy for bladder cancer: lessons learned last decade.

Orthotopic urinary diversion (OUD), or neobladder, is believed to be the gold standard for surgical bladder reconstruction following radical cystectomy though it is performed far less often than ileal conduits. As both a continent and intracavitary diversion, OUDs offer unique advantages for patients. Their utilization has decreased overall though, especially with the advent of robotic surgery. In this review, we will cover patient selection for OUD, functional outcomes (i.e., continence, sexual activity, quality of life [QoL]), and robotic orthotopic diversions. OUDs have seen a proportionally greater decline in utilization compared with ileal conduits as the number of robotic radical cystectomies being performed with intracorporeal diversions increases. Multiple robotic series have demonstrated less perioperative blood loss and shorter hospital stays when compared with the open approach though operative times are longer, the learning curve is steeper, and overall costs may be higher in some settings. Perioperative safety and short-term oncological outcomes appear comparable. Since robotic OUDs are relatively new, functional outcomes are not yet well established. Patient satisfaction with urinary diversion is associated with informed decision-making tailored to the patient. A thorough understanding of expected short- and long-term functional outcomes and the care required to maintain an OUD improves QoL and satisfaction with diversion choice. Given the potential advantages of OUD, its decreasing use is a remarkable trend. Shared decision-making and a patient-centered approach should be used when selecting the type of urinary diversion.

V13-07 PROPHYLACTIC MESH PLACEMENT AT TIME OF ILEAL CONDUIT CREATION: A SIMPLE SUBLAY TECHNIQUE

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-07 PROPHYLACTIC MESH PLACEMENT AT TIME OF ILEAL CONDUIT CREATION: A SIMPLE SUBLAY TECHNIQUE Da David Jiang, Kyle Gillis, Kenneth Softness, Nicholas Chakiryan, Alison Levy, Vitaliy Poylin, Andrew Wagner, and Peter Chang Da David JiangDa David Jiang More articles by this author , Kyle GillisKyle Gillis More articles by this author , Kenneth SoftnessKenneth Softness More articles by this author , Nicholas ChakiryanNicholas Chakiryan More articles by this author , Alison LevyAlison Levy More articles by this author , Vitaliy PoylinVitaliy Poylin More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , and Peter ChangPeter Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A prospective randomized study of prophylactic mesh placement at the time of cystectomy and ileal conduit found a significant reduction the cumulative incidence of parastomal hernias by approximately 50%.We present a novel simple sutureless prophylactic sublay permanent mesh placement at the time of ileal conduit creation. METHODS: Bard VentralightTM ST mesh is a permanent medium weight monofilament propylene mesh. It has an absorbable hydrogel barrier on the posterior side based on Sepraâ Technology (ST). A circular mesh with 6cm in diameter is formed; a cruciate cut is made centrally. The space between the posterior sheath and the rectus is bluntly dissected circumferentially. The conduit is brought out of the stoma site and the mesh is thread over the conduit with the shiny ST side down; the ST side is in contact with the conduit and prevents adhesions. The mesh is then gently tucked into the dissected space. The rest of the conduit is matured in standard fashion. RESULTS: We first placed prophylactic mesh in this fashion in 3/2019; since 8/2020, we perform this technique on every ileal conduit diversion. To date, 38 cases have been done; 34 via robotic intracorporeal diversion. Median follow up is 4 months (IQR 2-8). There have been no mesh-related complications such as mesh erosion, mesh infection, mesh pain, or need for mesh explant. The follow-up is too short to determine efficacy, but no clinically apparent parastomal hernias have developed. 21 patients had postoperative imaging with a median radiographic follow-up of 5 months (IQR 3-10); of these, 1 patient (5%) had radiographic evidence of a parastomal hernia. CONCLUSIONS: We present a novel simple sutureless technique for prophylactic mesh placement at time of ileal conduit creation. With short follow-up, there are no evidence of mesh-related complications. Longer follow-up is needed to determine efficacy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1080-e1080 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Da David Jiang More articles by this author Kyle Gillis More articles by this author Kenneth Softness More articles by this author Nicholas Chakiryan More articles by this author Alison Levy More articles by this author Vitaliy Poylin More articles by this author Andrew Wagner More articles by this author Peter Chang More articles by this author Expand All Advertisement Loading ...

Recovery of health-related quality of life in patients undergoing robot-assisted radical cystectomy with intracorporeal diversion.

To report the health-related quality of life (HRQoL) after robot-assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (EORTC-QLQ-C30) and EORTC-QLQ-Muscle-Invasive Bladder Cancer Module (EORTC-QLQ-BLM30) questionnaires before surgery and had a minimum of 12 months follow-up postoperatively. A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC-QLQ-C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90-day Clavien-Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02-0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03-0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC-QLQ-BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06-30.45; P = 0.005) of higher sexual function score at 12 months. While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway.