Is it prime time for stent-less robotic radical cystectomy? A scoping review

The gold standard treatment for muscle-invasive bladder cancer (MIBC) still is radical cystectomy. Thanks to better peri-operative results than open surgery, robotic-assisted radical cystectomy (RARC) has become somewhat well-known. Though they are linked with problems like infection, pain, and higher healthcare expenses, conventionally ureteral stents are used during urinary diversion to minimize anastomotic leaks and strictures. This has spurred growing interest in stent-less urinary diversion methods. To assess the present data on the feasibility, safety, efficacy, and clinical outcomes of stent-less robotic-assisted radical cystectomy and decide if the stent-less technique is ready for general clinical use, a comprehensive literature review was conducted using PubMed, EMBASE, and Cochrane databases with search terms: "robotic cystectomy," "ureteral stent," "stent-less urinary diversion," "complications," and "postoperative outcomes." Studies comparing outcomes of stented and stent-less RARC published in peer-reviewed journals were reviewed, with exclusion of pediatric studies and those exclusively focusing on open cystectomy. With respect to anastomotic integrity, complication rates, patient comfort, and cost-effectiveness, emerging studies show that stent-less RARC is viable in suitably selected patients and yields either comparable or possibly better results. Widespread acceptance is now limited, nonetheless, by variation in surgical procedures and institutional experience. Stent-less robotic cystectomy is interesting with possible benefits in terms of lower complications and higher patient satisfaction. Larger prospective randomized controlled trials and standardized surgical techniques are required, nonetheless, before suggesting regular use in clinical practice.