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Intracorporeal Versus Extracorporeal Urinary Diversion Following Robot-Assisted Radical Cystectomy: A Meta-Analysis, Cumulative Analysis, and Systematic Review - Beyond the Abstract

Robot-assisted radical cystectomy (RARC) had been increasingly performed in the last decade, this had also led to an uptrend in the urinary diversion using the intracorporeal approach following RARC. Intracorporeal urinary diversions (ICUD) following radical cystectomy have been considered technically very challenging with a steep learning curve and thought to have a high post-operative complication rate compared to extracorporeal urinary diversion (ECUD). We performed a meta-analysis and cumulative analysis to compare the peri-operative outcomes following ICUD vs ECUD following RARC.


Meta-analysis:

We included a total of 5 studies in the meta-analysis. Most of the data come from high-volume centers and International Robotic Cystectomy Consortium (IRCC). Except for less blood loss in the ICUD group compared to ECUD group operative time and postoperative complications are not significantly different between the two groups.

metaanalysisBTA.png

Cumulative analysis:

We included a total of 83 studies in this analysis. Data from the cumulative analysis may be more representative of the real-world data.

Operative time: ICUD neobladder seems to have less operative time compared to ECUD neobladder,

Blood loss: ICUD neobladder have less blood loss compared to ECUD neobladder

Early complications: ICUD seems to have more early complications

Late complications: ECUD seems to have more late complications

cumulativeanalysisBTA.png

To conclude although there was an uptrend in the ICUD still the majority of the urinary diversions are performed using ECUD, ICUD seems to have overall comparable outcomes to ECUD. The results should be viewed with caution as none of the studies are randomized and most of these results come from high volume centers where the procedures are performed routinely.

Written by: Karthik Tanneru, MD, and Joseph Costa, DO, Department of Urology, University of Florida, Jacksonville, FL

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