The Hood Technique for Robot-Assisted Radical Cystoprostatectomy with Intracorporeal Neobladder

The Hood technique, originally developed for robot-assisted prostatectomy, preserves periurethral and periprostatic structures critical for early continence recovery. Radical cystoprostatectomy requires wider pelvic dissection, bladder pedicle control, lymphadenectomy, and intraoperative urethral margin assessment, necessitating modification of the Hood approach. We adapted this continence-preserving dissection to robot-assisted radical cystoprostatectomy (RARC) with intracorporeal neobladder reconstruction. This study describes the technique and reports early feasibility, functional, and oncologic outcomes.

We retrospectively reviewed 40 male patients who underwent RARC with intracorporeal neobladder reconstruction using the Hood technique between 2019 and 2023. Continence was defined as using 0-1 pad/day or complete dryness with clean intermittent catheterization. Pad count, rather than pad weight testing, was used. Daytime and nighttime continence were assessed at standardized postoperative intervals, and time to continence was estimated using Kaplan-Meier analysis. Perioperative outcomes, complications, and oncologic outcomes were analyzed descriptively.

The median operative time was 335 minutes, estimated blood loss was 400 mL, and the length of hospital stay was 4 days. Major complications occurred in 7.5% of patients at 30 days and 10% at 90 days. Kaplan-Meier estimates for daytime continence were 36% at 6 weeks, 71% at 3 months, 92% at 6 months, and 92% at ≥12 months; corresponding nighttime continence estimates were 11%, 32%, 42%, and 62%. All surgical margins for urothelial carcinoma were negative. Limitations include the retrospective, single-center design, modest sample size, lack of a comparison group, and use of nonvalidated continence measures.

The Hood technique for RARC with intracorporeal neobladder reconstruction is technically feasible and associated with encouraging early continence recovery without evident short-term adverse oncologic outcomes, supporting further comparative evaluation.