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Bhatt R, Mittauer DJ, Vetter JM, Barashi NS, McGinnis R, Sands KG, Chow AK, Kim EH. Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction. Cureus 2024; 16:e56825. [PMID: 38659512 PMCID: PMC11040430 DOI: 10.7759/cureus.56825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Robot-assisted radical cystectomy (RARC) has become more accessible to surgeons worldwide, and descriptions of intracorporeal urinary diversion techniques, such as orthotopic neobladder construction, have increased. In this study, we aim to compare the rate of bladder neck contracture (BNC) formation between RARC and two different urinary diversion techniques. We retrospectively reviewed our institutional database for patients with bladder cancer who underwent RARC with intracorporeal neobladder (ICNB) construction (n = 11) or extracorporeal neobladder (ECNB) construction (n = 11) between 2012 and 2020. BNC was defined by the need for an additional surgical procedure (e.g., dilatation, urethrotomy). Patients who underwent RARC with ICNB (n = 11) were compared to patients who underwent RARC with ECNB (n = 11) across patient characteristics and postoperative BNC formation rates. Kaplan-Meier curves were generated for freedom from BNC based on the neobladder approach and compared with the log-rank test. For patients who received an ECNB, 73% (8/11) developed a BNC; in comparison, none of the patients in the ICNB group experienced a BNC. Kaplan-Meier survival analysis demonstrates the ECNB group's median probability of freedom from BNC as 1.3 years, while the ICNB group was free of BNC over the study period (p < 0.001). RARC with ICNB creation demonstrated a significantly reduced BNC rate in contrast to RARC with ECNB construction. Longer-term follow-up is needed to assess the durability of this difference in BNC rates.
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Affiliation(s)
- Rohit Bhatt
- Department of Urology, University of California Irvine Health, Orange, USA
| | - Dylan J Mittauer
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Joel M Vetter
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Nimrod S Barashi
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Riley McGinnis
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Kenneth G Sands
- Department of Urology, Washington University School of Medicine, St. Louis, USA
| | - Alexander K Chow
- Department of Urology, Rush University Medical Center, Chicago, USA
| | - Eric H Kim
- Department of Urology, Washington University School of Medicine, St. Louis, USA
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Yang R, Rac G, Felice MD, Pahouja G, Ko C, Okabe Y, Naha U, Chen VS, Druck A, Gupta GN, Woods ME, Gorbonos A, Quek ML, Patel HD. Robotic versus open radical cystectomy for bladder cancer: evaluation of complications, survival, and opioid prescribing patterns. J Robot Surg 2024; 18:10. [PMID: 38214872 DOI: 10.1007/s11701-023-01749-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 01/13/2024]
Abstract
We aim to compare complications, readmission, survival, and prescribing patterns of opioids for post-operative pain management for Robotic-assisted laparoscopic radical cystectomy (RARC) as compared to open radical cystectomy (ORC). Patients that underwent RARC or ORC for bladder cancer at a tertiary care center from 2005 to 2021 were included. Recurrence-free survival (RFS) and overall survival (OS) were evaluated with Kaplan-Meier curves and multivariable Cox proportional hazards regression models. Comparisons of narcotic usage were completed with oral morphine equivalents (OMEQ). Multivariable linear regression was used to assess predictors of OMEQ utilization. A total of 128 RARC and 461 ORC patients were included. There was no difference in rates of Clavien-Dindo grade ≥ 3 complications between RARC and ORC (36.7 vs 30.1%, p = 0.16). After a mean follow up of 3.4 years, RFS (HR 0.96, 95%CI 0.58-1.56) and OS (HR 0.69, 95%CI 0.46-1.05) were comparable between RARC and ORC. There was no difference in the narcotic usage between patients in the RARC and ORC groups during the last 24 h of hospitalization (median OMEQ: 0 vs 0, p = 0.33) and upon discharge (median OMEQ: 178 vs 210, p = 0.36). Predictors of higher OMEQ discharge prescriptions included younger age [(- )3.46, 95%CI (-)5.5-(-)0.34], no epidural during hospitalization [- 95.85, 95%CI (- )144.95-(- )107.36], and early time-period of surgery [(- )151.04, 95%CI (- )194.72-(- )107.36]. RARC has comparable 90-day complication rates and early survival outcomes to ORC and remains a viable option for bladder cancer. RARC results in comparable levels of opioid utilization for pain management as ORC.
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Affiliation(s)
- Rachel Yang
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA.
| | - Michael D Felice
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Gaurav Pahouja
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Caitlyn Ko
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Yudai Okabe
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Ushasi Naha
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Victor S Chen
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA.
| | - Aleksander Druck
- Department of Urology, University of South Florida, Tampa, FL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Michael E Woods
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Marcus L Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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