In recent years, robot-assisted radical cystectomy with intracorporeal urinary diversion has gained in popularity and the number of procedures performed has increased significantly. However, there is a paucity of data comparing the urodynamic profile of totally intracorporeal neobladders (iONB) with their open standard counterpart. The aim of this study was to compare the functional and urodynamic outcomes of open (oPIB) and totally intracorporal robotic Padua ileal neobladder (rPIB) reconstructions performed at a single high-volume centre.

Between June 2017 and December 2020 our prospective, board-approved, radical cystectomy dataset was queried for “urodynamic evaluation”, “open orthotopic ileal neobladder” (oPIB = Group A; n=19), “robotic intracorporeal orthotopic neobladder” (rPIB = Group B; n=24). Complete urodynamic profile including uroflowmetry, cystometry, compliance, presence of residual peristaltic activity, abdominal (ALPP) and Valsalva leak point pressures (VLPP) as functional outcomes assessed by daytime and night-time continence (defined as the use of 0-1 pad) and stress incontinence rates were compared between groups. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Differences between continuous variables were assessed with the t test, while Pearson’s χ2 test was used for categorical data. For all analyses, a two-sided p<0.05 was considered significant.

We obtained complete urodynamic evaluations of 43 patients: we considered patients’ characteristics such as BMI, gender, age, and urodynamic results, as shown in Table 1. A functional assessment considering the variables shown in Table 2 was also performed.

Overall, at a median follow-up of 15 months (IQR 9-26) 43 patients achieved a complete urodynamic evaluation (Table 1). When comparing urodynamic characteristics, no significant differences were observed between groups in terms of cystometric capacity, neobladder compliance, end-filling pressure, maximal flow rate, ALPP, VLPP and postvoid residual urine volume (each p>0.1). The rate of neobladder residual peristaltic activity was significantly increased in the rPIB series (70.8 vs 36%; p=0.02) while the amplitude of contractions was not significantly different between groups (p=0.89). In the oPIB cohort the daytime and nighttime continence rates were 94.1% and 70.6% while in the robotic series were 75% and 52.4%, respectively (each p>0.1; Table 2). Stress urinary incontinence rates were comparable between groups (p=0.235)

Compared to open standard technique, rPIB showed adequate cystometric capacity and compliance at an early follow-up despite an increased rate ofresidual peristaltic activity . The urodynamic and functional results support rPIB as a valid option comparable to oPIB for muscle-invasive bladder cancer.

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Simone G, Papalia R, Misuraca L et al Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. Eur Urol. 2018 Jun;73(6):934-940
Ferriero M, Simone G, Rocchegiani A et al . Early and late urodynamic assessment of Padua ileal bladder. Urology. 2009 Jun;73(6):1357-62