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Robotic versus Open Cystectomy with Ileal Conduit for the Management of Neurogenic Bladder: A Comparative Study - Beyond the Abstract

After conservative treatment failure, cystectomy with ileal conduit is part of the standard management of neurogenic bladder.1,2 Although the use of the robotic approach has been extensively evaluated for radical cystectomy with ileal conduit to treat bladder cancer,3,4 few data are currently available on its impact to perform this surgery to treat neurogenic bladder.5,6 Against this backdrop, we aimed to compare the peri- and postoperative outcomes of robot-assisted vs. open cystectomy to treat neurogenic bladder in our tertiary referral care center.

To that end, we included all consecutive patients who underwent robot-assisted or open cystectomy with ileal conduit for neurogenic bladder refractory to conservative treatment at La Pitié-Salpêtrière hospital in Paris between 2017 and 2021.

Overall, 123 patients were included in this study and further dichotomized in robot-assisted (n=85; 69.1%) and open (n=38; 30.9%) groups. We observed shorter operative time (205.8 ± 55.5 vs 266.9 ± 64 min, respectively; p<0.001), decreased blood loss (245.8 ± 169.6 vs 737.7 ± 518.8 ml, respectively; p<0.001) as well as shorter delay to feeding resumption (5.5 ± 2.9 vs 7.1 ± 4.7 days, respectively; p=0.05) and shorter length of hospital stay (16.2 ± 7.6 vs 21.6 ± 13.9 days, respectively; p=0.03) after robot-assisted vs open cystectomy with ileal conduit. A postoperative Clavien-Dindo >2 complications occurred in 24 (19.5%) patients including 4 (10.5%) in the robot-assisted group and 20 (23.5%) in the open group (p=0.1). Although there were fewer uretero-ileal strictures after robot-assisted vs. open cystectomy with ileal conduit (7.9% vs 23.5%, respectively),  the difference did not reach statistical significance (p=0.07).

To conclude, our study suggests that robot-assisted cystectomy with ileal conduit may provide better peri- and postoperative outcomes compared to open surgery for the management of neurogenic bladder after conservative treatment failure. These results support the development of the robotic approach in this setting.

Written by: Jeanne Beirnaert, Davy Benarroche, Ugo Pinar, Morgan Roupret, Véronique Phé, Christophe Vaessen, Jerome Parra, Emmanuel Chartier-Kastler, Thomas Seisen

APHP, Sorbonne University, GRC 5, Predictive Onco-Urology, Pitié-SalpêtrièreHôpital, Urology, Paris, France., APHP, Sorbonne University, Hôpital Tenon, Service d'Urologie, Paris, France.

References:

  1. Romo PGB, Smith CP, Cox A, et al (2018) Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol 36:1555–1568.
  2. Groen J, Pannek J, Castro Diaz D, et al (2016) Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 69:324–333.
  3. Zhou N, Tian F, Feng Y, et al (2021) Perioperative outcomes of intracorporeal robot-assisted radical cystectomy versus open radical cystectomy: A systematic review and meta-analysis of comparative studies. Int J Surg Lond Engl 94:106137.
  4. Bochner BH, Dalbagni G, Sjoberg DD, et al (2015) Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol 67:1042–1050.
  5. Deboudt C, Perrouin-Verbe M-A, Le Normand L, et al (2016) Comparison of the morbidity and mortality of cystectomy and ileal conduit urinary diversion for neurogenic lower urinary tract dysfunction according to the approach: Laparotomy, laparoscopy or robotic. Int J Urol Off J Jpn Urol Assoc 23:848–853.
  6. Haudebert C, Hascoet J, Freton L, et al (2022) Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches. Neurourol Urodyn 41:601-60

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Neurogenic Bladder Foundations