Robotic intracorporeal modified Bordeaux versus Padua ileal bladder: head-to-head surgical technique, perioperative
Riccardo Mastroianni1, Gabriele Tuderti2, Umberto Anceschi2
1Uro-Oncology Program, IRCCS Regina Elena National Cancer Institute, Rome, Italy - riccardo.mastroianni@ifo.it.
Background:
Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (iUD) has facilitated the development of several orthotopic neobladder (ON) configurations. However, comparative evidence between iON types remains limited. This study aimed to provide a head-to-head comparison between modified Bordeaux Neobladder (mBN) and Padua Ileal Bladder (PIB) in terms of surgical technique, perioperative outcomes and functional results.
Methods:
We prospectively analyzed patients from an IRB-approved database undergoing RARC with totally iON reconstruction between January 2022 and July 2025. Eligible patients had muscle-invasive bladder cancer or BCG-refractory high-grade NMIBC and received either mBN or PIB reconstruction by a single experienced robotic surgical team. Outcomes included operative time, transfusion rates, perioperative and early postoperative complications, diversion-related morbidity and continence recovery assessed through 3-day voiding diaries. Continuous variables were compared with Student's t-test, while categorical variables with χ2 Fisher's Exact Tests. Functional recovery was compared via Kaplan-Meier analyses and log-rank tests. A two-sided P value <0.05 was considered statistically significant.
Results:
Seventy-nine patients were included (38 mBN; 41 PIB). Baseline characteristics were comparable. Operative time (286±45 vs. 297±33 min; P=0.18), transfusion rates (11% vs. 17%; P=0.31) and hospital stay (7±7 vs. 6±3 days; P=0.41) showed no significant differences. Perioperative and 30-day complication rates were similar, as were 90-day outcomes. Uretero-ileal leakages (3% vs. 12%; P=0.12) and strictures (11% vs. 12%; P=1.00) occurred infrequently in both groups. Day- and night-time continence recovery and intermittent self-catheterization rates (8% vs. 15%; P=0.28) were comparable.
Conclusions:
In this single-center observational cohort, the modified Bordeaux Neobladder demonstrated perioperative and early functional outcomes comparable to those of the Padua Ileal Bladder after RARC with intracorporeal orthotopic diversion. These findings require confirmation in larger multicenter studies with longer follow-up and objective functional assessment.
