To develop contemporary evidence-informed recommendations for robot-assisted radical cystectomy (RARC), urinary reconstruction, and perioperative management, integrating current evidence with the experience of Latin American experts in uro-oncology and robotic surgery.
A modified Delphi consensus process was conducted involving 42 experts with extensive experience in RARC. Topics included patient selection, perioperative optimization, enhanced recovery after surgery (ERAS), lymph node dissection, urinary reconstruction, functional preservation, perioperative systemic therapy, complex clinical scenarios, and emerging robotic technologies. A comprehensive literature review was performed using Medline, Scopus, and Web of Science through November 2025, following PRISMA principles and incorporating recommendations from EAU, AUA/ASCO/SUO, and NCCN guidelines. Consensus was defined as ≥75% agreement.
Consensus supported routine implementation of ERAS protocols, structured frailty and nutritional assessment, extended pelvic lymph node dissection, and perioperative systemic therapy in eligible patients. Intracorporeal urinary diversion was associated with improved recovery and lower wound-related morbidity. Nerve-sparing and organ-preserving approaches were recommended in selected patients to optimize continence, sexual function, and quality of life. Orthotopic neobladder reconstruction should be individualized according to oncologic safety, functional status, renal function, and patient preference. RARC was considered feasible in complex settings, including obesity, bulky lymphadenopathy, locally advanced disease, and salvage surgery, when performed in experienced high-volume centers. Areas without consensus included urinary drainage strategies and antibiotic prophylaxis duration.
This expert consensus provides recommendations for RARC and urinary reconstruction, aiming to standardize practice, optimize perioperative care, and improve oncological and functional outcomes. Future prospective studies are needed.
International braz j urol : official journal of the Brazilian Society of Urology. 2026 Jan [Epub]
Eliney Ferreira Faria, Alejandro Rodrigues, Alexandre Pompeo, Arnaldo Fazoli, Carlos Vaz, Carlos Watanabe, Clovis Fraga, Daher Chade, Eder Brazão, Elias Bodden, Fernando Korkes, Flávio Cárcano, Francisco Hidelbrando, Gilberto Almeida, Gustavo Guimarães, Hamilton Zampoli, Joan Palou, Jose Alexandre Pedrosa, Lucas Fornazieri, Marcelo Kerkebe, Marcio Moschovas, Marcos Tobias-Machado, Matheus Nister, Matheus Paiva, Murilo Luz, Nilo Jorge, Pablo Melo, Pedro Romanelli, Peter Wiklund, Rafael Coelho, Rafael Rocha, Rene Sotelo, Reza Mehrazino, Roberto Machado, Rodolfo Borges, Rodrigo Valente, Ronald Kool, Stenio Zequi, Sérgio Zacchi, Vipul Patel, Wenceslao Villamil, Rodrigo Gualberto
Faculdade Ciências Médicas Minas Gerais, Belo Horizonte, MG, Brasil., North Carolina Wake Forest, Winston-Salem, NC, USA., Hospital do Coração, HCor, São Paulo, SP, Brasil., Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, SP, Brasil., Hospital Felício Rocho, Belo Horizonte, MG, Brasil., Hospital Sírio Libanês de Brasília, Brasília, DF, Brasil., Hospital Português, Recife, PE, Brasil., A. C. Camargo Cancer Center, São Paulo, SP, Brasil., Hospital Punta Pacífica, Panamá., Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil., Hospital Monte Klinikum, Fortaleza, CE, Brasil., Universidade do Vale do Itajaí - UNIVALI, Itajaí, SC, Brasil., Fundació Puigvert, Barcelona, Spain., Instituto Nacional do Câncer - INCA, Rio de Janeiro, RJ, Brasil., University of Chile. Santiago, Chile., Global Robotics Institute, Celebration, Florida, USA., Hospital Madre Teresa, Belo Horizonte, MG, Brasil., Santa Casa de Santos, Santos, SP, Brasil., Icahn School of Medicine at Mount Sinai, New York, USA., Rede Mater Dei Salvador, Salvador, BA, Brasil., Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG, Brasil., The Mount Sinai Hospital, NY, USA., Américas Medical City, Rio de Janeiro, RJ, Brasil., University of Southern California - USC, Los Angeles, CA, USA., Hospital de Amor, Barretos, SP, Brasil., Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil., Erasto Gaertner Cancer Center, Curitiba, PR, Brasil., Hospital Santa Rita de Cássia, Vitória, ES, Brasil., Hospital Italiano de Buenos Aires, CABA, Argentina.