Intracorporeal Studer pouch formation with Balbay's technique following robotic radical cystectomy for bladder cancer: Experience with 22 cases with oncologic and functional outcomes.

Robotic radical cystectomy (RARC) with intracorporeal Studer pouch formation (ICSPF) is increasingly being performed. Balbay's technique of ICSPF replicates open approach with the additional advantages of inserting internal JJ stents.

Between June 2011 and April 2019, 22 patients with muscle-invasive bladder cancer were included who underwent RARC and ICSPF with Balbay's technique. Mean follow-up was 35.7 months. Operative, postoperative, pathologic measures, complications, oncologic and functional outcomes were evaluated.

Mean operation time, estimated blood loss, mean lymph node yield, mean duration of hospital stay were 9.2 hours, 361.4 mL and 38.6, 10.5 days, respectively. Surgical margins were positive in 3(9.1%) patients. Postoperative pT stages included: pT0 (n=4), pTis (n=4), pT1 (n=2), pT2 (n=1), pT3a (n=3), pT3b (n=5) and pT4a (n=3). Day-time continence outcomes were (patients with ≥1-year follow-up, n=17): 10 (58.8%) fully continent, 4 (23.5%) mild, 3 (17.7%) moderate incontinence. 2-year cancer specific survival, overall survival and recurrence-free survival were 68.6%, 66.0% and 69.7%, respectively. Retrospective nature was the main limitation. Complications (modified Clavien-Dindo classification, n=32) included 23 minor and 2 major during perioperative (0-30 days) period; 3 minor and 4 major during postoperative (31-90 days) period. Ileus developed in 3 patients (9.3%) Readmission rates were 3 (13.6%) and 8 (36.4%) perioperative and postoperative periods, respectively.

RARC and ICSPF by Balbay's technique has acceptable morbidity, excellent surgical and pathological outcomes and satisfactory oncologic and functional results with additional advantages of exclusion of external stents, exact replication of open approach and less gastrointestinal complications.

Journal of endourology. 2019 Nov 15 [Epub ahead of print]

Mevlana Derya Balbay, Abdullah Erdem Canda, Murat Can Kiremit, Ersin Koseoglu

Amerikan Hastanesi, 64090, Urology, Güzelbahçe Sok No 20, Nişantaşı, Istanbul, Turkey, 34365; ., Koc University, School of Medicine, Department of Urology, Topkapi, Istanbul, Turkey, 34010., Koc University School of Medicine, 145809, urology, Istanbul, Turkey; ., Urology, koc university hospital, Istanbul, Turkey, 34010; .