EAU 2018: Functional Outcomes after Robot-Assisted Radical Cystectomy
Canda et al. assessed functional outcomes in 25 patients undergoing RARC and intracorporeal urinary diversion [1]. Among available data on 18 patients, 11 were fully continent, four had mild and two had severe day-time incontinence. In a subsequent analysis of 70 patients undergoing total intracorporeal neobladder urinary diversion and RARC, Tyritzis et al. found that daytime continence and satisfactory sexual function or potency at 12 months ranged between 70% and 90% in both men and women [1]. Specifically, in male patients with nerve-sparing the potency rate was 66% and 20% in those with non-nerve sparing.
Dr. Jeong followed this introduction by discussing the outcomes at the Korea University and his single-surgeon experience at the Samsung Medical Center. At Korea University, there was no difference in 3-, 6-, and 12- month continence rates between patients undergoing extracorporeal and intracorporeal urinary diversions. Among 48 males undergoing RARC and orthotopic neobladder with a minimum of 12 months of follow-up, potency rates were 73.3% without PDE5 inhibitors for patients with preop IIEF >12 (n=15). Among Dr. Jeong’s personal experience of 138 cases of RARC between August 2008 and December 2017, telephone surveys were answered by 35 patients. Among this subset of patients, 77% had no incontinence and 14% had mild incontinence. The median recovery of continence was 6.0 months (IQR 3.0-12.0 months). Erectile function was assessed by question #1 of the IIEF-5 questionnaire, specifically asking about erectile function over the past 6 months; there were 57% of patients that had appropriate erections. To summarize, Dr. Jeong notes that day-time continence rates were 91%, night-time continence rates were 79% and potency rates were 57%.
Dr. Jeong concluded stating that continence rates after RARC and orthotopic urinary diversion is associated with comparable outcomes to open radical cystectomy. Potency after RARC with neurovascular bundle salvage is excellent compared to open radical cystectomy.
Presented by: Byong Chang Jeong, Samsung Medical Center, Seoul, Republic of Korea
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark
References:
1. Canda AE, Atmaca AF, Altinova S, et al. Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases. BJU Int 2012;110(3):434-444.
2. Tyritzis SI, Hosseini A, Collins J, et al. Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol 2013;64(5):734-741.