Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review

Abstract

Robot-assisted radical cystectomy with intracorporeal urinary diversion is one of the most challenging procedures in urological surgery. Over the past 15 years, this procedure has gained in popularity and the number of procedures performed has increased significantly. While ileal conduit remains the most common diversion, orthotopic neobladders are also formed in a few expert centres that have developed their technique for totally intracorporeal neobladder. The objective of this review is to summarise the techniques currently used to perform totally intracorporeal neobladder with a special focus on their functional outcomes, such as continence or sexual function. The techniques described are the Karolinska-modified Studer neobladder, the USC-modified Studer neobladder, the pyramid pouch, the Y-pouch, and the vesica Ileale Padovana, some trying to totally reproduce the steps of open surgery and others trying to simplify them. Functional outcomes vary depending on the technique performed. Standardisation in assessing outcomes is lacking, as well as objective outcome measurements with questionnaires or urodynamic assessments. Current evidence shows acceptable functional outcomes after totally intracorporeal neobladder construction, but larger prospective randomised series with longer follow-up, better defined outcomes, and more objective measurements are needed in the future.

Keywords: Functional outcomes; Intracorporeal; Neobladder; Robot-assisted radical cystectomy; Urinary diversion.