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 ; ^{gillindy@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 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.

Objective

To evaluate urodynamic features of iONB and bladder cancer–specific and general health-related quality-of-life (HRQOL) outcomes.

Design, setting, and participants

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.

Outcome measurements and statistical analysis

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.

Results and limitations

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 cm³ (range 339–1001). 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.

Conclusions

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

Patient summary

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.