Impact of transvaginal extraction on continence after robotic cystectomy with orthotopic neobladder

PURPOSE: Robot-assisted radical cystectomy (RARC) with totally intracorporeal orthotopic neobladder (i-ON) is increasingly used. Functional outcomes in women remain under-investigated due to the limited number of female patients undergoing i-ON.The aim of the present study is to identify predictors of daytime and nighttime continence recovery in female patients undergoing i-ON METHODS: We retrospectively analysed our IRB-approved single-center database for female patients treated with RARC and i-ON between January 2016 and July 2022. Women receiving sex-sparing approaches were excluded. Continence status was assessed with 3-day voiding diaries. Daytime continence was defined as total dryness (0 g) and nighttime continence as pad wetness ≤50 g. Kaplan–Meier curves and log-rank tests compared recovery; Cox regression identified predictors. RESULTS: Thirty-five female patiens were included. Median age was 62 years (IQR 55–66) and BMI 24,5 kg/m2 (IQR 21.5–28.0). High-grade complications (Clavien ≥3) occurred in 11%. Suprapubic specimen extraction was associated with higher daytime continence recovery (logrank p=0,01), while nighttime continence did not differ. On multivariable analysis, transvaginal extraction independently predicted a 65% reduced Accepted manuscriptprobability of daytime continence recovery (HR 0.35, 95% CI 0.14–0.89; p=0.03). No effect was observed for nighttime continence (p=0.86). CONCLUSIONS: Transvaginal specimen extraction negatively affected daytime but not nighttime continence recovery. Validation in larger, multi-institutional cohorts with longer follow-up is warranted.