Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical cystectomy (RARC) is increasingly adopted globally.
• Urinary diversion techniques, including orthotopic neobladder construction, are evolving.
• Bladder neck contracture (BNC) is a potential complication after radical cystectomy.

Purpose of the Study:

• To compare the incidence of bladder neck contracture (BNC) between intracorporeal neobladder (ICNB) and extracorporeal neobladder (ECNB) construction following RARC.
• To evaluate the impact of different neobladder approaches on postoperative BNC formation.

Main Methods:

• Retrospective review of patients undergoing RARC with either ICNB or ECNB between 2012 and 2020.
• Definition of BNC as requiring additional surgical intervention (e.g., dilatation, urethrotomy).
• Kaplan-Meier analysis and log-rank testing to compare freedom from BNC between the two groups.

Main Results:

• A significantly higher rate of BNC was observed in the ECNB group (73%, 8/11) compared to the ICNB group (0%).
• The median time to BNC for the ECNB group was 1.3 years, whereas the ICNB group remained free of BNC throughout the study period.
• Statistical analysis confirmed a significant difference in BNC rates between the ICNB and ECNB approaches (p < 0.001).

Conclusions:

• Robot-assisted radical cystectomy with intracorporeal neobladder construction is associated with a substantially lower rate of bladder neck contracture compared to extracorporeal neobladder construction.
• The ICNB technique appears to be a safer option regarding BNC development post-RARC.
• Further long-term studies are warranted to confirm the durability of these findings.