Platinum Priority – Bladder CancerEditorial by Fiona C. Burkhard on pp. 254–255 of this issueRobotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-related Quality of Life
Introduction
There is significant uptake of robotic radical cystectomy (RRC) in the treatment of muscle-invasive bladder cancer. In appropriately selected patients, creation of an orthotopic neobladder (ONB) is the preferred urinary diversion at our center. Robotic creation of an intracorporeal ONB (iONB) has been demonstrated and adopted as part of a completely robotic cystectomy procedure [1]. Although there are data on the technical efficiency and complications related to robotic iONB, urodynamic functional assessments of intracorporeally constructed neobladders are lacking [2]. It remains to be seen whether entirely robotic creation of iONBs has comparable functional metrics and general and health-related quality of life (HRQOL) scores specifically related to orthotopic substitution, such as pad use.
The primary objective of this study was to report quantifiable urodynamic parameters to assess whether robotically created iONBs behave as low-pressure, high-volume reservoirs. As a secondary aim, validated instruments were used to compare continence outcomes and general and HRQOL scores related to orthotopic bladder substitution between robotic and open approaches.
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Study subjects
Consenting patients who underwent RRC and iONB were prospectively followed in a database approved by the institutional review board (IRB). Inclusion criteria included male patients, no technical complications directly related to neobladder that could impact neobladder function, and completion of at least 3-mo follow-up after surgery. We identified 39 patients who underwent robotic iONB creation between January 2012 and October 2013 by one of three robotic surgeons (M.A, M.D, or I.S.G). Three
Results
A total of 28/32 (88%) eligible male patients who underwent robotic iONB completed follow-up questionnaires. Of these 28 patients, 12 (43%) agreed to undergo multichannel UDS measurement. The mean preurodynamic PVR was 82 cm3 (range 0–325 cm3). None of the 12 patients exhibited detrusor (neobladder) overactivity during the cystometry filling phase. The average compliance was normal (mean 33 ml/cm H2O, range 13–74) and nine of the 12 patients had compliance >30 ml/cm H2O. The mean cystometric
Discussion
To the best of our knowledge, this is the first study to assess UDS characteristics and orthotopic diversion-specific and generic HRQOL together with pertinent functional outcomes (patterns of pad use) following robotic iONB creation. UDS parameters confirmed that the robotic procedure created a low-pressure, high-volume ONB. BCI urinary function and bother scores were comparable between the open and robotic cohorts. Worse BCI scores were associated with diabetes, but not the surgical technique
Conclusions
Our UDS data confirm that robotic iONB creation recapitulates the necessary characteristics of a high-volume, low-pressure reservoir. Robotic iONB appears to display comparable health states to open diversion using a multidimensional measure of bladder cancer–specific HRQOL. However, given that pad size and daytime wetness were worse, ongoing follow-up and prospective comparison are required to assess long-term urinary continence rates.
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“Bordeaux Neobladder”: First Evaluation of the Urodynamic Outcomes
2023, European Urology Open ScienceCitation Excerpt :Enterocystometric capacity is determined by a strong desire to void or when it is absent with an onset of leakage beside the cystometric catheter. In the study of Satkunasivam et al [20], the median capacity was 514 ml (330–1001) for a 60-cm Studer ONB. These values relate to normal compliance (median 33 ml/cmH2O) and no neobladder overactivity, but seem to be correlated with a higher PVR after UDS (268 ml).
Robot assisted radical cystectomy with Florence Robotic Intracorporeal Neobladder (FloRIN): Functional and urodynamic features compared with a contemporary series of open Vescica Ileale Padovana (VIP)
2022, European Journal of Surgical OncologyCitation Excerpt :Compliance was defined as change in volume per increase in detrusor pressure (ml/cm H2O) during filling phase. Although no universal consensus exists regarding optimal neobladder compliance, it has been suggested that values > 12.5–30 ml/cm H2O might be considered as the lower normal limit [10,11]. In case of sudden increase or fluctuation of detrusor pressure, the latter was measured after pressure curve was stabilized.
Robot-assisted-radical-cystectomy with total intracorporeal Y neobladder: Analysis of postoperative complications and functional outcomes with urodynamics findings
2022, European Journal of Surgical OncologyCitation Excerpt :Few studies focused on this aspect in the past. The USC group [28], reproducing Studer technique and using 60 cm of ileum, had a median neobladder capacity of 514 ml (330–1001 ml). This determined a normal compliance (median 33 ml/cmH2O) without neobladder overactivity, but is related to high PVR (mean PVR = 268 ml).