Follow-up analysis of 40 cases of robotic intracorporeal studer orthotopic neobladder in a single center / 中华泌尿外科杂志

ABSTRACT

Objective:To explore the curative effect of robotic intracorporeal studer orthotopic neobladder (RISON).Methods:The clinical data of 40 patients who underwent RISON in our hospital from April 2018 to March 2020 were analyzed retrospectively, including 39 males and 1 female with an average age of (56.4±9.9)years, an average body mass index of (25.5±3.1) kg/m 2. Four patients received preoperative neoadjuvant chemotherapy. Comorbidity component index score was 0-2 points in 6 cases, 3-5 points in 33 cases, 6-8 points in 1 case. All patients had definite pathological diagnosis for the high grade urothelial carcinoma or recurrent bladder tumors, and the tumor staging forecast within T 2 stage. Biopsy of the posterior urethra and bladder neck revealed negative result of tumor invasion. The patients had normal kidney function and without any clear bowel disease history. All patients underwent robotic radical intracorporeal studer orthotopic neobladders and standard lymphadenectomy. About 30 to 40 cm from terminal ileum was selected as the new bladder neck and 50 cm ileum as neobladder. Restore intestinal continuity with EndoGIA. The intestinal canal was cut off along the offside of mesentery except for proximal 10 cm. After U-shape suture of the new bladder back wall, the new anterior bladder wall was sutured with barbs line further in pulp muscularis. "Wallace" was performed bilateral ureteral anastomosis and closing the proximal end of the anterior wall of the new bladder. Further follow-up results were also collected to evaluate the clinical treatment effect, including pathological results of tumor, bladder capacity, urine control (usage of pads), sexual function, short-term(≤30 d) and long-term(>30 d) complications. Results:All the RISONs were successfully performed without conversion to open operation. Median operation time was 360(300.0, 442.5) min, blood loss was 200(200.0, 337.5) ml, indwelling time of gastric tube was 3(3, 4)d, full tolerance time was 3(3, 5)d, and postoperative hospital stay was 9(8, 10)d. Postoperative pathological results showed 39(97.5%) cases were no more than T 2N 0M 0, 1 case was confirmed T 3aN 0M 0 pathologically, 1 case was positive in surgical margin, 1 case was diagnosed as incidental prostate cancer, 15(12, 20) lymph nodes were dissected and no lymph node metastasis was found. Short-term (within 30 days) complications occurred in 12 patients, including Clavien grade Ⅰ 7 cases, Clavien grade Ⅱ 5 cases. Long-term (out of 30 days) complications occurred in 18 patients, including Clavien grade Ⅰ 10 cases, Clavien grade Ⅱ 7 cases, Clavien grade Ⅲ 1 case. And the follow-up time was 1 to 24 months. The median bladder volume 300 (0, 400)ml of 25 patients who were followed up for more than one year and 1 in 34 female patient developed incontinence. Other 33 patients had continence rate of 93.9% (0 pad) during the day, and needed regular urination at night (1-3 times), with an average of 2 pads. All 11 patients with nerve-sparing achieved satisfactory erectile function after operation, with an average IIEF-6 score of (21.5±2.7). No tumor recurrence or death occurred in all patients during the follow-up period. Conclusions:Robotic intracorporeal studer orthotopic neobladder is a safe and feasible urinary diversion operation. The patients achieved good clinical efficacy in tumor control, bladder volume, daytime and nighttime continence, sexual function recovery.