Robotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-related Quality of Life

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• 作者：Raj Satkunasivam ; Michael Santomauro ; Sameer Chopra ; Elisabeth Plotner ; Jie Cai ; Gus Miranda ; Salpi Salibian ; Monish Aron ; David Ginsberg ; Siamak Daneshmand ; Mihir Desai ; Inderbir S. Gill<sup> ; sup><sup>gillindy@gmail.com" class="auth_mail" title="E-mail the corresponding authorsup>
• 关键词：Urothelial cancer ; Radical cystectomy ; Robot-assisted radical cystectomy ; Orthotopic neobladder ; Intracorporeal orthotopic neobladder ; Health-related quality of life ; Functional outcomes ; Incontinence ; Urodynamics
• 刊名：European Urology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：69
• 期：2
• 页码：247-253
• 全文大小：1209 K

文摘

Intracorporeal orthotopic neobladder (iONB) creation following robotic radical cystectomy is an emerging procedure and robust functional data are required.

sSec_2">Objective

spar0010">To evaluate urodynamic features of iONB and bladder cancer&ndash;specific and general health-related quality-of-life (HRQOL) outcomes.

sSec_3">Design, setting, and participants

spar0015">We retrospectively assessed 28 men who underwent iONB creation (January 2012 to October 2013) and compared results to a previously characterized cohort of 79 of open ONB procedures.

sSec_4">Outcome measurements and statistical analysis

spar0020">iONB pressure-volume properties were characterized using multichannel urodynamics (UDS). The Bladder Cancer Index (BCI) questionnaire, modified with mucus- and pad-related questions, and the Short Form Health Survey (SF-36) were used to evaluate urinary function and HRQOL. ONB cohorts were compared for functional outcomes and BCI score. Multivariable linear regression was used to assess predictors of BCI score.

sSec_5">Results and limitations

spar0025">The median follow-up was 9.4 mo for the iONB and 62.1 mo for the open ONB group (p < 0.0001); ≥2-yr follow-up had been completed for one (4%) patient in the iONB group compared to 75 (95%) patients in the open ONB group (p < 0.0001). In UDS tests, the iONB group had minimal postvoid residual volume, normal compliance, and a mean capacity of 514 cm<sup>3sup> (range 339&ndash;1001). BCI mean scores for urinary function (p = 0.58) and urinary bother (p = 0.31) were comparable between the groups. The surgical approach was not associated with the BCI score on multivariable analysis. Rates of 24-h pad use were comparable between iONB and open ONB groups (pad-free 17% vs 19%; ≤2 pads 84% vs 79%), as reflected by total pad usage (p = 0.1); pad size and daytime wetness were worse in the iONB group. The clean intermittent catheterization rate was 10.7% in the iONB and 6.3% in the open ONB group. Limitations include the retrospective comparison, small number of patients and short follow-up for the iONB group.

sSec_6">Conclusions

spar0030">iONB had adequate UDS characteristics and comparable bladder cancer&ndash;specific HRQOL scores to open ONB. However, pad size and daytime wetness were worse for iONB, albeit over significantly shorter follow-up.

sSec_7">Patient summary

spar0035">We demonstrate that the volumetric and pressure characteristics are acceptable for a neobladder created using an entirely robot-assisted laparoscopic technique after bladder removal for cancer. Urinary function and quality-of-life outcomes related to the robotic technique were compared to those for neobladders created via an open surgical technique. We found that urinary function and bother indices were comparable; however, the robotic group required larger incontinence pads that were wetter during the daytime. This may be explained by the significantly shorter duration of recovery after surgery in the robotic group.