Is patient outcome compromised during the initial experience with robot-assisted radical cystectomy? Results of 164 consecutive cases

Perioperative and functional outcomes of single-port versus multi-port robotic-assisted radical cystectomy: evidence-based on controlled studies

To compare perioperative outcomes of robot-assisted radical cystectomy (RARC) using a single-port (SP) or multi-port (MP) robotic platform. We conducted a comprehensive search of the PubMed, Web of Science, Scopus, and Google Scholar databases until June 2024. For a combined analysis of the data using random effects, Review Manager 5.4 was employed. To compare continuous and categorical variables, the weighted mean difference (WMD) and odds ratio (OR) were employed, respectively. Three original studies were included, comprising a total of 170 patients (SP-RARC: 73 versus MP-RARC: 93).Recovery of bowel function was faster in SP-RARC (WMD -1.02 days, 95% CI - 1.33 to - 0.17; p < 0.001), and lymph-node yield was lower than in MP-RARC patients (WMD - 6.32, 95% CI - 8.90 to - 3.75; p < 0.00001).There were no significant differences between the SP-RARC and MP-RARC groups in terms of other perioperative outcomes such as surgery duration, length of hospital stay, estimated blood loss, major complication rate, positive surgical margin rate, readmission rate, and recurrence rate. The SP robot offers a safe alternative surgical approach to RARC, providing similar postoperative outcomes compared to the MP robot. The SP system remains an attractive option that will require longer follow-up and cohort validation in the future.

Learning Curve of a Novel Three-Port Laparoscopic Radical Cystectomy with Urinary Diversion: A Single-Center Retrospective Analysis

Objective: Three-port laparoscopic radical cystectomy (LRC) is a novel method of radical cystectomy, which is being spread by our team in primary hospitals in our country. The purpose of this study was to evaluate the learning curve of urologists using this technique for bladder cancer patients. Methods: We retrospectively evaluated clinical data from patients with bladder cancer who received three-port LRC with urinary diversion at our medical center between January 2018 and December 2021. Consecutive cases were grouped according to different surgical years, and perioperative parameters among groups were assessed as variables for the learning curve, including operative time, estimated blood loss (EBL), lymph nodes (LN) yield, and postoperative hospital stay. Results: We assessed 154 patients who were divided into three groups, all of which were comparable in terms of preoperative characteristics. With the increase in surgical experience, the operation time of urologists is obviously reduced (P < .05), especially after 100 surgeries, whereas no statistically significant difference was observed in terms of EBL, LN yield, and postoperative hospital stay in the different surgical experience groups (P > .05). Conclusions: Our early learning curve experience indicates that the three-port LRC with urinary diversion is a safe and feasible technique that can be mastered by urologists after learning from a large sample. Given its advantages in cost and significantly improved learning curve, we recommend this technique to surgeons with extensive laparoscopic experience.

The learning curve for robot-assisted radical cystectomy with total intracorporeal urinary diversion based on radical cystectomy pentafecta

Objective

To analyze the learning curve for robot- assisted radical cystectomy (RARC) with total intracorporeal urinary diversion (ICUD) in terms of both time efficiency and quality of surgery based on radical cystectomy (RC)-pentafecta.

Patients and methods

We identified 203 consecutive patients who underwent RARC with ICUD of the ileal conduit (IC, 85) and orthotopic neobladder (ONB, 118) performed by a single surgeon between 2011 and 2021. We grouped ten consecutive patients into time-associated blocks according to the operation order. Process efficiency and operation quality were measured based on the surgeon’s console time and attainment/score sum of RC-pentafecta. The overcoming point of the learning curve was defined graphically and statistically.

Results

The mean follow-up period was 44.5 ± 30.7 months. Of the 203 patients, 109 (53.7%) attained the five criteria of RC-pentafecta (ONB vs IC, 50.6% vs. 55.9%, p = 0.35). The attainment rate and sum of the RC-pentafecta score of the third group were not significantly different from those of all patients (40.0% vs. 53.7%, p = 0.369, 4.00 ± 1.05 vs. 4.41 ± 0.75, p = 0.137, respectively), and the proficiency in operation quality was satisfactory in the third group. The console times continually improved and stabilized after the 140^th case (IC, 60; ONB, 80), and the attainment rate and sum of the RC-pentafecta were significantly different between before and after the 140^th case (p<0.001).

Conclusion

A single surgeon’s learning curve for RARC with ICUD and pelvic lymph node dissection (PLND) showed an acceptable level of proficiency after 30 consecutive cases in terms of the operation quality. However, for an expert surgeon, 140 cases were required to reach a plateau in time efficiency and second leap with the RC-pentafecta. RARC with ICUD and PLND can be performed safely without compromising functional outcomes and complications through sharing and transmission of standardized techniques.

Short-term morbidity and mortality following radical cystectomy: a systematic review

OBJECTIVE

To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these.

DESIGN

Systematic review.

METHODS

The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale.

RESULTS

The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC.

CONCLUSION

Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC.

PROSPERO REGISTRATION NUMBER

104937.

Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer

The current status of robot-assisted radical cystectomy was reviewed 16 years after the initial robot-assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot-assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot-assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot-assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high-volume centers, robot-assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer-specific survival benefits. Robot-assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot-assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.

Robot assisted radical cystectomy versus open radical cystectomy in bladder cancer (RACE): study protocol of a non-randomized comparative effectiveness study

Background

Despite the fact that the cost-effectiveness of robot-assisted radical cystectomy (RARC) is not yet proven, and open radical (ORC) cystectomy is recommended as the standard of care in patients with high-risk non-muscle-invasive and muscle-invasive bladder cancer, the use of RARC is still increasing. The objective of the current ongoing comparative effectiveness trial therefore is to study the (cost-)effectiveness of RARC compared to ORC, both in terms of objective (complication rates, oncological outcomes) and patient-reported (health-related quality of life) outcome measures.

Methods

This study is designed as a non-randomized, multicentre comparative effectiveness trial.

Centres with an annual caseload of > 20 radical cystectomies can include patients after informed consent has been given. Centres that perform RARC must have passed the (initial) learning curve of 40 cases. A total of 338 (2 × 169) patients will be enrolled from 23 participating centres (12 ORC, 10 RARC and 1 LRC). Follow-up visits will be scheduled at 1, 3, 6 and 12 months. During each follow-up visit, clinical data and health-related quality of life questionnaires will be administered. Costs will be studied using a monthly resource usage questionnaire. Impact on complications and quality of life will be calculated as the average difference between the groups with 95% confidence intervals, adjusted for potential baseline differences by means of propensity score matching.

Discussion

This study aims to contribute to the development of evidence-based guidelines regarding the most cost-effective surgical technique for radical cystectomy.

Trial registration

Nederlands Trial Register/Dutch Trial Registry, trial identifying number: NTR5362. Registered on 14 August 2015. (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5362).

Robot-assisted laparoscopic radical cystectomy with extracorporeal urinary diversion: Initial experience and outcomes

INTRODUCTION

Open radical cystectomy (ORC) is the most common surgical approach for invasive carcinoma of the urinary bladder, but robot-assisted radical cystectomy (RARC) has recently gained popularity. There is limited data from the Indian subcontinent on RARC. The aim of this study was to assess the perioperative, pathological, and oncological outcomes of RARC and follow-up in our initial 63 cases.

MATERIALS AND METHODS

A retrospective analysis of prospectively maintained data of 63 RARC procedures performed in our tertiary care institute from July 2006 to January 2016 was done. All patients underwent RARC with extracorporeal urinary diversion. We analyzed perioperative parameters, length of hospital stay, pathological and oncological outcomes, and rate of complications. Follow-up data were analyzed for disease recurrence and survival.

RESULTS

The mean age of the patients was 58 years. The mean American Society of Anesthesiologists (ASA) score was 1.66. Mean operative time was 348.6 min and mean blood loss was 868.2 ml. Mean hospital stay was 10.4 days (±5.4 days). 42.8% patients had pT2 disease, 49.2% pT3, 1.58% pT1, and 6.34% had pT4 disease. Mean lymph node yield was 12.4 (3-25). One patient had positive surgical margins. Twenty-four patients had postoperative complications of which four were major complications (Clavien-Dindo 3 or higher). At a median follow-up of 60 months (range: 3-108 months), 11 patients were lost to follow-up 10 patients developed metastasis, out of which 4 died. Four had recurrence, two died and two are receiving chemotherapy.

CONCLUSION

This study shows the feasibility and safety of RARC. The operative time, blood loss, return of bowel activity and hospital stay were higher than those reported in the literature but may reflect the learning curve.

Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist's Perspective from a Multicentre Study

BACKGROUND

Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC).

OBJECTIVE

To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment.

DESIGN, SETTING, AND PARTICIPANTS

Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013.

INTERVENTION

RARC or ORC combined with perioperative chemotherapy for UBC.

OUTCOME MEASURES AND STATISTICAL ANALYSIS

Fisher's exact tests, χ² tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors.

RESULTS AND LIMITATIONS

A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation.

CONCLUSIONS

In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint.

PATIENT SUMMARY

In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.

Systematic review and meta-analysis of randomised trials of perioperative outcomes comparing robot-assisted versus open radical cystectomy

Background

With the introduction of robotic surgery, whether the robot-assisted radical cystectomy (RARC) could reduce the perioperative morbidity compared with Open radical cystectomy (ORC) was unknown.

Methods

Studies reported RARC were reviewed based on all randomized controlled trials (RCTs), which focused on the efficacy of RARC versus ORC.

Results

Of the 201 studies from preliminary screening, four RCTs were included. By pooling these studies, there were significant differences in comparison of operative time (p = 0.007), estimated blood loss (EBL) (p < 0.001) and time to diet (p < 0.001) between the RARC group and ORC groups. There was no significant difference regarding perioperative complications (Clavien 2–5, Clavien 3–5), length of stay (LOS), positive surgical margins (PSM) and lymph node positive.

Conclusion

This meta-analysis presented evidence for a benefit of EBL, time to diet, similar perioperative complications and oncological outcomes, but a longer operative time in RARC. It is noted that RARC was considered as a comparable surgical procedure to ORC.

Partial nephrectomy in the setting of metastatic renal cell carcinoma

PURPOSE

Cytoreductive nephrectomy remains the standard of care for appropriately selected patients with metastatic renal cell carcinoma. Although the role of partial nephrectomy is well accepted in patients with localized disease, limited data are available on partial nephrectomy in the metastatic setting. We identified the indications for and outcomes of partial nephrectomy in the setting of metastatic renal cell carcinoma with particular attention to partial nephrectomy subgroups.

MATERIALS AND METHODS

We analyzed data on a consecutive cohort of 33 patients with metastatic renal cell carcinoma who underwent partial nephrectomy at a single institution between 1996 and 2011. Nonparametric statistics were used to compare partial nephrectomy subgroups. Overall survival was estimated using the Kaplan-Meier method and survival functions were compared using the log rank test.

RESULTS

At presentation 8 patients had bilateral synchronous renal masses, 20 had a metachronous contralateral renal mass and 5 had a unilateral renal mass. A total of 22 patients (67%) died of disease a median of 27 months postoperatively. Patients who underwent partial nephrectomy for a metachronous contralateral renal mass and a renal mass 4 cm or less had the best overall survival (61 and 42 months, respectively). Median overall survival in patients with vs without metastatic disease at original diagnosis was 27 vs 63 months (p = 0.003).

CONCLUSIONS

Our findings suggest that metastasis at the original diagnosis and the timing of presentation of the partial nephrectomy index lesion have an important role in survival. These factors should be considered when determining which patients would benefit from partial nephrectomy in the setting of metastatic renal cell carcinoma.

Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases

OBJECTIVES

To validate the feasibility and implications of a hybrid procedure using perineal and abdominal approaches for a radical prostatocystectomy.

METHODS

Between March 2007 and May 2012, we performed 16 prostatocystectomy and simultaneous urethrectomy under a hybrid procedure using perineal and abdominal approach for advanced bladder cancer. The hybrid procedure was selected in each case, because of prostatic urethra involvement in 13 and prior treatment in 3 (irradiation, radical retropubic prostatectomy, and sigmoidectomy, respectively). Two surgical teams, one responsible for the perineal approach and the other for the abdominal portion, performed the operation.

RESULTS

The median operation time for the prostatocystectomy procedure was 207 minutes and median intraoperative blood loss was 1665 ml. The en bloc removal of the specimen was perfectly performed and no intraoperative difficulties and intraoperative complications such as rectal injury were recognized in all cases. As for postoperative complications associated with the exaggerated lithotomy position, neurologic complications and rhabdomyolysis which could be treated conservately were found in 1 case. Although 5 patients died from distant metastasis, local recurrence was not seen in any of the 16 patients during the follow-up period.

CONCLUSION

The hybrid procedure using perineal and abdominal approach for radical prostatocystectomy is a well-organized procedure that can provide good visualization of the surgical structure around the prostate, leading to a reduction in or prevention of local recurrence and surgical complications even in the selected patient.

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

Robot-assisted radical cystectomy (RARC) for bladder cancer is increasingly becoming popular in specialist centres around the world. RARC has the advantage of being minimally invasive and also the dexterity of the instruments allow reconstruction such as ileal conduit urinary diversion or neobladder formation. Starting from the initial series demonstrating the feasibility of RARC and extended pelvic lymph node dissection, we now have mature series demonstrating equal oncological and functional outcomes in the medium term follow-up. In addition, literature suggests decreased hospital stay, less blood loss equating to less blood transfusion and a trend towards decreased complications as well. In the near future we would anticipate further refinement and reduced operating times with increased benefits for the patient undergoing RARC.

Comparison of robotic-assisted and open radical cystectomy in a community-based, non-tertiary health care setting

We examined the safety and feasibility of transitioning from open radical cystectomies to robotic-assisted laparoscopic cystectomies in a community-based, non-tertiary health care setting. A retrospective review and analysis of our most recent 14 unselected consecutive patients who underwent open cystectomy was compared to our first 14 unselected consecutive patients who underwent robotic-assisted laparoscopic cystectomy. Perioperative and pathologic outcomes were reviewed to determine the safety and oncologic equivalence of the two procedures. From 2003 to 2010, 14 consecutive patients underwent an open cystectomy and from 2010 to 2012 another 14 consecutive patients underwent a robotic-assisted laparoscopic cystectomy. The operative time was significantly longer in the robotic group (6 h 23 min vs. 4 h 28 min; p < 0.05) and intraoperative blood loss was significantly lower compared with the open radical cystectomy (ORC) group (470 ml vs. 942 ml; p < 0.05). Regarding complications, 21 % of robotic-assisted radical cystectomy (RARC) patients experienced major complications versus 14 % of ORC patients. Overall, there was no statistically significant difference in complication rates or length of hospital stay between the ORC and RARC groups. No pathologic differences were noted between the two groups and lymph node counts were similar in the two groups, with the median numbers being 11.9 and 9.5 in RARC and ORC, respectively. RARC can be accomplished in a community-based, non-tertiary health care setting without compromising perioperative or pathologic outcomes during the institution of this minimally invasive procedure.

Recent advances in the diagnosis and treatment of bladder cancer

Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.

Prevention and management of complications following robot-assisted radical cystectomy: lessons learned after >250 consecutive cases

INTRODUCTION

Numerous case series of robot-assisted radical cystectomy have emerged which describe complication rates comparable to open series. However, various reports have outlined preoperative factors as predictors of postoperative complications. Understanding these factors and the methods to optimize the perioperative care of the robotic cystectomy patient is essential for successful outcomes.

METHODS

In this topic paper, we briefly review the literature surrounding complication rates following robot-assisted radical cystectomy as well as describe our experience after >250 cases, outlining our suggestions for avoidance of surgical complications when building a practice that incorporates this technique.

RESULTS

Due to numerous variables, there are a number of intra-operative considerations, including patient selection, perioperative care pathway, intra-operative technique, and equipment choice that we have found to decrease post-operative complications and improve patient outcomes.

CONCLUSION

Through careful patient selection, use of appropriate equipment and perioperative surgical management, robotic cystectomy is a feasible procedure with excellent perioperative results.

Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer

OBJECTIVES

Oncologic outcomes of robotic cystectomy have focused on pathology and not on survival endpoints. We compared pathology, recurrence, and survival in a single surgeon series of open and robotic cystectomy since the introduction of robotic cystectomy.

METHODS

We identified all patients treated by a single surgeon with radical cystectomy for urothelial cancer from June 2007 to June 2010. Clinical, demographic, and pathologic data was abstracted from chart review. Mortality was obtained from institutional cancer registry and chart review. Patients were excluded from analysis for a relative contraindication to robotic surgery. The remaining cohort of patients undergoing robotic (n = 36) vs. open (n = 29) cystectomy with median follow-up 12.2 months were evaluated.

RESULTS

The robotic cohort was more likely to be older and male (P < 0.05). Obesity, comorbidity, preoperative pathology, and receipt of neoadjuvant chemotherapy were not different between groups. Three patients had conversion from robotic to open cystectomy because of difficult dissection. Mean surgical time was longer in robotic cystectomy (410 vs. 345 minutes, P < 0.01). Cystectomy pathology was not different for robotic vs. open surgery for stage, margin status, or mean node count (robotic: 17.0, open: 15.5). On survival analysis robotic and open cystectomy outcomes were similar with respect to recurrence-free, disease-specific, and overall survival (all log-rank P values > 0.05). The Kaplan-Meier estimate for 2-year outcome for recurrence-free, disease-specific, and overall survival was 67% (95% CI: 41-83), 75% (95% CI: 53-88), 68% (95% CI: 47-82) for robotic cystectomy and 58% (95% CI: 29-79), 63% (95% CI: 34-82), 63% (95% CI: 34-82) for open cystectomy.

CONCLUSIONS

Short-term oncologic outcomes were similar for open and robotic cystectomy. Increased sample size and further follow-up are necessary before claiming equivalent long-term survival.

[Robot-assisted radical cystectomy. Pilot study for the prospective evaluation of perioperative parameters compared to open radical cystectomy]

BACKGROUND

For robot-assisted radical cystectomy prospective assembly and evaluation of peri- and postoperative parameters within a national database is planned. This pilot study evaluated which parameters should be assessed and which problems might occur for assembly and interpretation of data.

PATIENTS AND METHODS

Of 84 patients with radical cystectomy, 14 underwent RARC. Evaluable patients were compared to patients with open radical cystectomy (ORC) regarding perioperative parameters. In addition, a literature review on published single-center RARC series and comparative investigations (RARC vs ORC) was performed. Published data were compared to results of our own series.

RESULTS

RARC patients received less packed red blood cells [RARC: 0 (0-2), ORC 2 (0-12), p=0.009] and hospitalization was shorter [RARC: 14 (8-18) days, ORC: 18 (11-97) days, p=0.015]. Comorbidities as assessed by the Charlson Comorbidity Index were less common in RARC patients [RARC: 4 (3-8), ORC: 6 (3-11), p=0.11]. No major differences between our own and published results were observed. The rate of continent urinary diversions in the Düsseldorf RARC cohort was, apart from one study, larger. Problems in the assembly and interpretation of operation time, blood loss, transfusion rate, and postoperative recovery were observed.

CONCLUSIONS

Even in this small cohort results of published studies were confirmed. Potential problems in data assembly were identified. Appropriate solutions will be implemented in the national database.