Cystectomy and ileal conduit is an option for selected patients with neurogenic lower urinary tract dysfunction (NLUTD) refractory to more conservative therapeutic options. The choice of a cystectomy with ileal urinary diversion for neurological bladder or major incontinence is a last resort and definitive choice. In the majority of cases, this type of surgery is performed for patients with invasive bladder cancer. However, neurological patients receiving an cystectomy with ileal non continent diversion are not the same as patients undergoing cystectomy for oncological matters. Complications of cystectomy and non-continuous ilael diversion in neurological patients remain poorly evaluated, and the main studies found are small effective.
The objective of the present study was to report the postoperative complications of cystectomy and ileal conduit for NLUTD and to assess the predictive factors of postoperative complications in this population.

All patients who underwent cystectomy and ileal conduit for NLUTD between October 2002 and November 2020 in an academic center were included in a retrospective study. Cystectomy and ileal diversion was chosen for several type of symptoms : urinary incontinence which affects quality of life, urinary tract infections, urinary retention (if the patient cannot perform self-catheterization)  or if the patient presented upper urinary tract deterioration due to his neurological bladder. 
The surgery was done either open, laparoscopic or robot-assisted depending on the period and the surgeon preference (three consecutive cohorts). The diversion was done either intracorporeally or extracorporeally . 
Data regarding early (90-day) and late (occurring after 90 days) postoperative complications were collected and complications were grade according to the Claiven-Dindo classification. The primary outcome was major complications defined as complications with Clavien-Dindo score ≥ 3. Multivariate logistic regression analysis was performed to identify factors associated with complications.

After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%) (Table 1). 
The approach was open, laparoscopic or robot-assisted in 31(24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. 
Seventy-two patients presented a 90-day post-operative complication (57.1%) of which 21 had a major complication (16.7%) including one death (0.8%). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The only factor significantly associated with a lower risk of major  postoperartive complications  was the robotic approach (OR=0.30; CI95%: 0.09-0.87; p=0.027; see table).

Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high peri-operative morbidity, similar to the one reported for radical cystectomy. The robot-assisted approach may decrease the risk of major postoperative complications.

Cystectomy and ileal conduit for neurogenic bladder may be required for patients with a neurological condition. Robotic surgery may be performed to reduce the risk of major post operative complications.