• John G Pattaras, James O Peabody, Vassilis Poulakis, Raj S Pruthi, Kamran Ahmed, Joan Palou Redorta, Shahid A Khan, Koon-Ho Rha, Matthew H Hayn, Lee Richstone, Piyush K Agarwal, Matthias Saar, Douglas S Scherr, Ketan K Badani, Stefan Siemer, M Derya Balbay, Erik P Castle, Prokar Dasgupta, Michael Stoeckle, Reza Ghavamian, Eric M Wallen, Khurshid A Guru, Alon Z Weizer, Ashok K Hemal, Peter Wiklund, Brent K Hollenbeck, Timothy Wilson, Adam S Kibel, Michael Woods, Mani Menon, Muhammad Shamim Khan, Alex Mottrie, and Kenneth Nepple.
• MRC Centre for Transplantation, King's College London, Department of Urology, Guy's Hospital, London, UK.
• Eur. Urol. 2014 Feb 1; 65 (2): 340-7.

BackgroundIntracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance.ObjectiveTo compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC).Design, Setting, And ParticipantsWe reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011.InterventionAll patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally.Outcome Measurements And Statistical AnalysisDemographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables.Results And LimitationsOf 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p=0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p=0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p=0.02). Being a retrospective study was the main limitation.ConclusionsRobot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.Copyright © 2013. Published by Elsevier B.V.

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