Reinforcing expectations after robot-assisted intracorporeal orthotopic neobladder: long-term functional, urodynamic and metabolic outcome

Purpose: Robotic-assisted radical cystectomy (RARC) with complete intracorporeal orthotopic neobladder offers a less invasive reconstruction of continent urinary diversion to the open approach. The aim was to evaluate long-term functional, urodynamic, and metabolic outcomes after RARC with intracorporeal orthotopic neobladder. Methods: In this retrospective study, 18 consecutive patients (16 men, median age 67 years) undergoing RARC for urothelial carcinoma with intracorporeal orthotopic neobladder between November 2015 and May 2021 were included. Video urodynamic evaluations assessed neobladder capacity, pressure at maximum filling, ureteral reflux and post-void residual volume. Continence was evaluated by questionnaires and pad count. Laboratory values were retrieved from the clinic information system. A subgroup of patients underwent both early and a late with video urodynamic studies were performed. Results: Median time between RARC with intracorporeal orthotopic neobladder reconstruction and late postoperative studies was 60 months. Urodynamic measurements showed a median maximum neobladder capacity of 485 mL (interquartile range (IQR), 433–625) and a maximum neobladder pressure of 20 cmH₂O (IQR, 11–25). The daytime continence rate (≤ 1 pad) was 89% (16/18 patients), while the nighttime rate was 61% (11/18 patients). Intermittent self-catheterization was needed in 28%. Bicarbonate substitution was required in 22% (4/18) of patients. In 50% (9/18) of patients with an additional early postoperative study after 11 months, urodynamic, functional, and metabolic changes were stable between early and late studies (all, p > 0.05). Conclusions: This patient series reports comprehensive long term urodynamic, functional, and metabolic results five years after RARC with intracorporeal orthotopic neobladder reconstruction. In a subgroup analysis, neobladder function, renal function, and metabolic status remained stable between early and late postoperative assessments, which may indicate favorable long-term outcomes.