Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Urology Reports
Published in: Current Urology Reports 5/2018

01-05-2018 | Endourology (P Mucksavage, Section Editor)

Updates on Robotic Intracorporeal Urinary Diversions

Authors: Shawn Dason, Alvin C. Goh

Published in: Current Urology Reports | Issue 5/2018

Login to get access

Abstract

Purpose of Review

More than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery.

Recent Findings

In this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles. Several potential benefits of intracorporeal urinary diversion are being investigated—such as a reduction in gastrointestinal complications, ureteral strictures, and wound complications. Finally, we highlight the important aspects of establishing an intracorporeal urinary diversion program integrated with an Enhanced Recovery after Surgery (ERAS) program. We have included the perioperative outcomes of 100 consecutive cases of intracorporeal urinary diversion with an Enhanced Recovery after Surgery (ERAS) protocol. In this series, 49% were continent diversions. Patients had a median length of stay of 5 days, with 37% staying 4 days or less. High-grade complications and readmissions were noted in 22 and 20% of patients, respectively.

Summary

The benefits of intracorporeal urinary diversion appear promising, and there is continued need for high-quality randomized controlled trials to define its role in patients undergoing radical cystectomy.
Literature
1.
Menon M, Hemal A, Tewari A, et al. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003;92(3):232–6.CrossRefPubMed
2.
Beecken W-D, Wolfram M, Engl T, Bentas W, Probst M, Blaheta R, et al. Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol. 2003;44(3):337–9.CrossRefPubMed
3.
Bachman AG, Parker AA, Shaw MD, Cross BW, Stratton KL, Cookson MS, et al. Minimally invasive versus open approach for cystectomy: trends in the utilization and demographic or clinical predictors using the National Cancer Database. Urology. 2017;103:99–105.CrossRefPubMed
4.
Goh AC, Aghazadeh MA, Krasnow RE, Pastuszak AW, Stewart JN, Miles BJ. Robotic intracorporeal continent cutaneous urinary diversion: primary description. J Endourol. 2015;29(11):1217–20.CrossRefPubMedPubMedCentral
5.
Goh AC, Gill IS, Lee DJ, de Castro Abreu AL, Fairey AS, Leslie S, et al. Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol. 2012;62(5):891–901.CrossRefPubMed
6.
7.
Cerruto MA, D'Elia C, Siracusano S, Porcaro AB, Cacciamani G, de Marchi D, et al. Is health-related quality of life after radical cystectomy using validated questionnaires really better in patients with ileal orthotopic neobladder compared to ileal conduit: a meta-analysis of retrospective comparative studies. Current Urology. 2016;10(2):57–68.CrossRef
8.
Crozier J, Hennessey D, Sengupta S, Bolton D, Lawrentschuk N. A systematic review of ileal conduit and neobladder outcomes in primary bladder cancer. Urology. 2016;96:74–9.CrossRefPubMed
9.
Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, et al. ICUD-EAU international consultation on bladder cancer 2012: urinary diversion. Eur Urol. 2013;63(1):67–80.CrossRefPubMed
10.
Gore JL, Litwin MS, Project UDiA. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol. 2009;27(1):45–50.CrossRefPubMed
11.
Roghmann F, Becker A, Trinh Q-D, Djahangirian O, Tian Z, Meskawi M, et al. Updated assessment of neobladder utilization and morbidity according to urinary diversion after radical cystectomy: a contemporary US-population-based cohort. Can Urol Assoc J. 2013;7(9–10):E552–60.CrossRefPubMedPubMedCentral
12.
Wein AJ, Kavoussi LR, Partin AW, et al. Campbell-Walsh Urology: Elsevier Limited, Oxford; 2016.
13.
Chang SS, Bochner BH, Chou R, et al. Treatment of non-metastatic muscle-invasive bladder Cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol 2017.
14.
15.
Niver BE, Daneshmand S, Satkunasivam R. Female reproductive organ-sparing radical cystectomy: contemporary indications, techniques and outcomes. Curr Opin Urol. 2015;25(2):105–10.CrossRefPubMed
16.
Goh AC, Abreu A, Mercado M, Sotelo R, Fernandez G, Aron M, Gill IS, Desai M Female organ-sparing robotic cystectomy: a step-by-step anatomic approach. Videourology 2014;28(1).
17.
Tan WS, Lamb BW, Kelly JD. Evolution of the neobladder: a critical review of open and intracorporeal neobladder reconstruction techniques. Scand J Urol. 2016;50(2):95–103.CrossRefPubMed
18.
Duckett J, Snyder H 3rd. Use of the Mitrofanoff principle in urinary reconstruction. Urol Clin North Am. 1986;13(2):271–4.PubMed
19.
Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder. Chirurgie Pediatrique. 1980;21(4):297–305.PubMed
20.
Furrer MA, Roth B, Kiss B, Nguyen DP, Boxler S, Burkhard FC, et al. Patients with an orthotopic low pressure bladder substitute enjoy long-term good function. J Urol. 2016;196(4):1172–80.CrossRefPubMed
21.
Stein JP, Skinner DG. Surgical atlas the orthotopic T-pouch ileal neobladder. BJU Int. 2006;98(2):469–82.CrossRefPubMed
22.
Stein JP, Lieskovsky G, Ginsberg DA, et al. The T pouch: an orthotopic ileal neobladder incorporating a serosal lined ileal antireflux technique. J Urol. 1998;159(6):1836–42.CrossRefPubMed
23.
Skinner EC, Fairey AS, Groshen S, Daneshmand S, Cai J, Miranda G, et al. Randomized trial of studer pouch versus t-pouch orthotopic ileal neobladder in patients with bladder cancer. J Urol. 2015;194(2):433–40.CrossRefPubMed
24.
Ahmadi H, Skinner EC, Simma-Chiang V, Miranda G, Cai J, Penson DF, et al. Urinary functional outcome following radical cystoprostatectomy and ileal neobladder reconstruction in male patients. J Urol. 2013;189(5):1782–8.CrossRefPubMed
25.
Hautmann RE, De Petriconi R, H-w G, et al. The ileal neobladder: complications and functional results in 363 patients after 11 years of followup. J Urol. 1999;161(2):422–8.CrossRefPubMed
26.
Novara G, Ficarra V, Minja A, de Marco V, Artibani W. Functional results following vescica ileale Padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires. Eur Urol. 2010;57(6):1045–51.CrossRefPubMed
27.
Studer UE, Danuser H, Thalmann GN, Springer JP, Turner WH. Antireflux nipples or afferent tubular segments in 70 patients with ileal low pressure bladder substitutes: long-term results of a prospective randomized trial. J Urol. 1996;156(6):1913–7.CrossRefPubMed
28.
Shaaban AA, Abdel-Latif M, Mosbah A, et al. A randomized study comparing an antireflux system with a direct ureteric anastomosis in patients with orthotopic ileal neobladders. BJU Int. 2006;97(5):1057–62.CrossRefPubMed
29.
Ginsberg D, Huffman JL, Lieskovsky G, Boyd S, Skinner DG. Urinary tract stones: a complication of the Kock pouch continent urinary diversion. J Urol. 1991;145(5):956–9.CrossRefPubMed
30.
Simon J, Bartsch G, Küfer R, et al. Neobladder emptying failure in males: incidence, etiology and therapeutic options. J Urol. 2006;176(4):1468–72.CrossRefPubMed
31.
Smith AB, Crowell K, Woods ME, Wallen EM, Pruthi RS, Nielsen ME, et al. Functional outcomes following radical cystectomy in women with bladder cancer: a systematic review. Eur Urol Focus. 2017;3(1):136–43.CrossRefPubMed
32.
Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–76.CrossRefPubMed
33.
Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57(2):196–201.CrossRefPubMed
34.
Khan MS, Gan C, Ahmed K, Ismail AF, Watkins J, Summers JA, et al. A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2016;69(4):613–21.CrossRefPubMed
35.
•• Parekh D. PNFLBA-18 A prospective, multicenter, randomized trial of open versus robotic radical cystectomy (RAZOR). J Urol. 2017;197(4):e918. The RAZOR trial is a multi-institutional RCT of robotic radical cystectomy versus open radical cystectomy, which found similar survival outcomes at 2 years but a higher bladder positive surgical margin rate. CrossRef
36.
Parekh DJ, Messer J, Fitzgerald J, Ercole B, Svatek R. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189(2):474–9.CrossRefPubMed
37.
•• Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Euro Urol. 2015;67(6):1042–50. This RCT showed no difference in complications for robotic cystectomy with extracorporeal diversion versus open cystectomy. CrossRef
38.
Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65(2):340–7.CrossRefPubMed
39.
• Pyun JH, Kim HK, Cho S, et al. Robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparative analysis with extracorporeal urinary diversion. J Laparoendosc Adv Surg Tech. 2016;26(5):349–55. Wound complications were lower following robotic cystectomy with intracorporeal urinary diversion. CrossRef
40.
Desai MM, Gill IS, de Castro Abreu AL, Hosseini A, Nyberg T, Adding C, et al. Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. J Urol. 2014;192(6):1734–40.CrossRefPubMed
41.
• Tan WS, Lamb BW, Tan M-Y, Ahmad I, Sridhar A, Nathan S, et al. In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion. Eur Urol Focus. 2017;3(2–3):273–9. Complications analyzed from a large intracorporeal urinary diversion series. CrossRefPubMed
42.
Shah SH, Movassaghi K, Skinner D, Dalag L, Miranda G, Cai J, et al. Ureteroenteric strictures after open radical cystectomy and urinary diversion: the University of Southern California experience. Urology. 2015;86(1):87–91.CrossRefPubMed
43.
Studer UE, Burkhard FC, Schumacher M, Kessler TM, Thoeny H, Fleischmann A, et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J Urol. 2006;176(1):161–6.CrossRefPubMed
44.
Ahmed YE, Hussein AA, May PR, Ahmad B, Ali T, Durrani A, et al. Natural history, predictors and management of ureteroenteric strictures after robot assisted radical cystectomy. J Urol. 2017;198:567–74.CrossRefPubMed
45.
Prentis JM, Trenell MI, Vasdev N, French R, Dines G, Thorpe A, et al. Impaired cardiopulmonary reserve in an elderly population is related to postoperative morbidity and length of hospital stay after radical cystectomy. BJU Int. 2013;112(2):E13–9.CrossRefPubMed
46.
Tolchard S, Angell J, Pyke M, Lewis S, Dodds N, Darweish A, et al. Cardiopulmonary reserve as determined by cardiopulmonary exercise testing correlates with length of stay and predicts complications after radical cystectomy. BJU Int. 2015;115(4):554–61.CrossRefPubMed
47.
Lamb BW, Tan WS, Eneje P, et al., editors. Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: a prospective cohort study. Urologic Oncology: Seminars and Original Investigations. Elsevier. 2016
48.
Pruthi RS, Nix J, McRackan D, Hickerson A, Nielsen ME, Raynor M, et al. Robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol. 2010;57(6):1013–21.CrossRefPubMed
49.
Azzouni FS, Din R, Rehman S, Khan A, Shi Y, Stegemann A, et al. The first 100 consecutive, robot-assisted, intracorporeal ileal conduits: evolution of technique and 90-day outcomes. Eur Urol. 2013;63(4):637–43.CrossRefPubMed
50.
Guru KA, Mansour AM, Nyquist J. Robot-assisted intracorporeal ileal conduit ‘Marionette’technique. BJU Int. 2010;106(9):1404–20.CrossRefPubMed
51.
Jonsson MN, Adding LC, Hosseini A, Schumacher MC, Volz D, Nilsson A, et al. Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder. Eur Urol. 2011;60(5):1066–73.CrossRefPubMed
52.
Canda AE, Atmaca AF, Altinova S, Akbulut Z, Balbay MD. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int. 2012;110(3):434–44.CrossRefPubMed
53.
Studer UE, Zingg EJ. Ileal orthotopic bladder substitutes: what we have learned from 12 years’ experience with 200 patients. Urol Clin N Am. 1997;24(4):781–93.CrossRef
54.
de Castro Abreu AL, Chopra S, Azhar RA, et al. Robotic radical cystectomy and intracorporeal urinary diversion: the USC technique. Indian J Urol. 2014;30(3):300.CrossRef
55.
Schwentner C, Sim A, Balbay MD, Todenhöfer T, Aufderklamm S, Halalsheh O, et al. Robot-assisted radical cystectomy and intracorporeal neobladder formation: on the way to a standardized procedure. World J Surg Oncol. 2015;13(1):3.CrossRefPubMedPubMedCentral
56.
Simone G, Papalia R, Misuraca L, Tuderti G, Minisola F, Ferriero M, Vallati G, Guaglianone S, Gallucci M Robotic intracorporeal Padua ileal bladder: surgical technique, perioperative, oncologic and functional outcomes. Eur Urol 2016.
57.
Hussein AA, Ahmed YE, Kozlowski JD, May PR, Nyquist J, Sexton S, et al. Robot-assisted approach to ‘W’-configuration urinary diversion: a step-by-step technique. BJU Int. 2017;120(1):152–7.CrossRefPubMed
58.
•• Satkunasivam R, Santomauro M, Chopra S, et al. Robotic intracorporeal orthotopic neobladder: urodynamic outcomes, urinary function, and health-related quality of life. Eur Urol. 2016;69(2):247–53. This is the first in-depth analysis of the functional outcomes of intracorporeal ileal neobladder supporting similar functional results compared to open neobladder. CrossRefPubMed
59.
Rowland RG, Mitchell ME, Bihrle R, Kahnoski RJ, Piser JE. Indiana continent urinary reservoir. J Urol. 1987;137(6):1136–9.CrossRefPubMed
60.
Desai MM, Simone G, de Castro Abreu AL, Chopra S, Ferriero M, Guaglianone S, et al. Robotic intracorporeal continent cutaneous diversion. J Urol. 2017;198(2):436–44.CrossRefPubMed
61.
Collins JW, Tyritzis S, Nyberg T, Schumacher MC, Laurin O, Adding C, et al. Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder—what is the effect of the learning curve on outcomes? BJU Int. 2014;113(1):100–7.CrossRefPubMed
62.
Desai MM, De Abreu ALC, Goh AC, et al. Robotic intracorporeal urinary diversion: technical details to improve time efficiency. J Endourol. 2014;28(11):1320–7.CrossRefPubMed
63.
Wilson TG, Guru K, Rosen RC, Wiklund P, Annerstedt M, Bochner BH, et al. Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel. Eur Urol. 2015;67(3):363–75.CrossRefPubMed
64.
Hayn MH, Hussain A, Mansour AM, Andrews PE, Carpentier P, Castle E, et al. The learning curve of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2010;58(2):197–202.CrossRefPubMed
65.
Azhar RA, Bochner B, Catto J, Goh AC, Kelly J, Patel HD, et al. Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol. 2016;70(1):176–87.CrossRefPubMedPubMedCentral
66.
Koupparis A, Villeda-Sandoval C, Weale N, el-Mahdy M, Gillatt D, Rowe E. Robot-assisted radical cystectomy with intracorporeal urinary diversion: impact on an established enhanced recovery protocol. BJU Int. 2015;116(6):924–31.CrossRefPubMed
67.
Collins JW, Adding C, Hosseini A, Nyberg T, Pini G, Dey L, et al. Introducing an enhanced recovery programme to an established totally intracorporeal robot-assisted radical cystectomy service. Scand J Urol. 2016;50(1):39–46.CrossRefPubMed
Metadata
Title
Updates on Robotic Intracorporeal Urinary Diversions
Authors
Shawn Dason
Alvin C. Goh
Publication date
01-05-2018
Publisher
Springer US
Published in
Current Urology Reports / Issue 5/2018
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-018-0778-z

Other articles of this Issue 5/2018

Current Urology Reports 5/2018 Go to the issue

Female Urology (L Cox, Section Editor)

Neuromodulation for Chronic Pelvic Pain

Female Urology (L Cox, Section Editor)

Female Pelvic Medicine and Reconstructive Surgery—What Does Certification Mean?

Pediatric Urology (D Weiss, Section Editor)

The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction

Endourology (P Mucksavage, Section Editor)

Robotic Autotransplantation and Management of Post-transplant Anastomotic Strictures: the Future Is Here

Pediatric Urology (D Weiss, Section Editor)

Benefits of Retroperitoneoscopic Surgery in Pediatric Urology

Endourology (P Mucksavage, Section Editor)

Advances in Ureteral Stent Design and Materials