There is very little data on robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RASCAC) in adult neurological patients. The objective of this study was to compare the perioperative outcomes of RASCAC with extracorporeal (RASCAC-EXTRA) vs. intracorporeal (RASCAC-INTRA) diversion in adults.

The charts of all patients who underwent a RASCAC for neurogenic lower urinary tract dysfunction (NLUTD) refractory to conservative treatments between October 2015 and April 2021 in three centers were retrospectively reviewed. The diversion was done extracorporeally between 2015 and 2019 and intracorporeally thereafter.  The procedures were performed by four surgeons, two in their learning curve and two with an experience of > 100 robotic cases. The preoperative and 3 months postoperative assessments included bladder diaries, urodynamics and the ICIQ-SF, Qualiveen SF and USP questionnaires. Complications were recroded and grade according to the Clavien classification. Major complications were defined as complications with a Clavien grade 3 or higher. The continence status postoperatively was categorized as complete continence (no pad), improved continence or unchanged continence.

Seventeen patients were enrolled over the study period: seven RASCAC-EXTRA and ten RASCAC-INTRA. Two conversions to an open approach were required in the RASCAC-EXTRA group (28.6% vs. 0%; p=0.15). The operative time was shorter in the RASCAC-INTRA group (309.5 vs. 432.9 min; p=0.01). The length of hospital stay was comparable in both groups (6.5 vs. 8.4 days; p=0.99). The estimated blood loss tended to be higher in the RASCAC-EXTRA group (92 vs 50 mL; p=0.07). The rate of post-operative complications was higher in the RASCAC-EXTRA and RASCAC-INTRA groups but this difference did not reach statistical significance (50% vs. 71.4%; p=0.38). Among these complications, only two were Clavien ≥ 3 (11.7%), one in each group (p=0.99). The time to oral feeding  and time to return of bowel function were significantly shorter in the RASCAC-INTRA group (2.3 vs. 4.1 days; p=0.03 and 2 vs. 4.4 days; p=0.02 respectively). The rates of complete continence at 3 months were similar in both groups (75% vs. 57.1%; p=0.31). The readmission rate did not differ significantly between both groups (20% vs.42.9%; p=0.59).

Robot-assisted supratrigonal cystectomy and augmentation cystoplasty appears to be technically feasible in adult neurological patients. The perioperative outcomes were comparable in the intracorporeal and extracorporeal groups but there was an earlier return of bowel function in the INTRA group

Robot-assisted supratrigonal cystectomy and augmentation cystoplasty is technically feasible in adult neurological patients either with intracoproeal or extracorporeal urinary diversion. Further studies are warranted to assess its possible benefits over other existing surgical approaches