OBJECTIVE: To describe the a robotic assisted intracorporeal Pyramid neo-bladder (NB) reconstruction technique and report operative and peri-operative metrics, post-operative upper tract imaging, neo-bladder functional outcomes and oncological outcomes.
PATIENTS AND METHODS: A total of 19 male and 1 female patients with a mean age 57.2±12.4 years (range: 31.0-78.2 years) underwent robotic assisted radical cystectomy (RARC). Most cases were ≤ pT1 (n=17), while the remaining three patients had muscle invasive bladder cancer (MIBC) at RARC histopathology although 50% (n=10) actually had MIBC at transurethral resection histopathology. All patients underwent RARC, bilateral pelvic lymphadenectomy and intracorporeal NB formation using a pyramid detubularised folding pouch configuration.
RESULTS: Median estimated blood loss was 250 ml and median operating time was 5.5 hours. The mean number of lymph nodes removed was 16.5±7.8 and median hospital stay was 10 days. Early postoperative complications include urinary tract infection (UTI) (n=4), ileus (n=4), diarrhoea and vomiting (n=3), post-operative collection (n=2), and blocked stent (n=1). Late postoperative complications include UTI (n=7), NB stone (n=2), voiding hem-o-loc (n=2), NB leak (n=2), diarrhoea and vomiting (n=1), uretero-ileal stricture (n=1), vitamin B12 deficiency (n=1) and port site hernia (n=1). There was no evidence of hydronephrosis in 18 patients with a median follow-up of 21.5 months. At 24 months, recurrence free survival was 86% and overall survival was 100%. Nineteen patients and 13 patients report 6 month day time and night time continence respectively.
CONCLUSIONS: The pyramid NB is technically feasible using a robotic platform and provides satisfactory functional outcomes at median of 21.5 months.
Written by:
Tan WS, Sridhar A, Goldstraw M, Zacharakis E, Nathan S, Hines J, Cathcart P, Briggs T, Kelly JD. Are you the author?
Department of Urology, University College London Hospital, Division of Surgery and Interventional Science, University College London, London, UK.
Reference: BJU Int. 2015 Jun 1. Epub ahead of print.
doi: 10.1111/bju.13189
PubMed Abstract
PMID: 26033321