title: Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal Indiana pouch continent cutaneous urinary diversion.
abstract: OBJECTIVE
  To evaluate the functional outcomes and complications for patients with bladder cancer undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion.
  
  
  METHODS
  From February 2004 to March 2010, 34 patients underwent robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction. After surgery, the complications were identified, categorized, and graded using an established 5-grade modification of the original Clavien grading system, and continence was assessed. Descriptive statistics were used in evaluating the outcomes. Fischer's exact test was used in the comparison of early and late Clavien grade III complications.
  
  
  RESULTS
  Overall, 175 (123 early and 52 late) complications after surgery were reported in 32 (94%) of 34 patients. Within 90 days of surgery, 31 (91%) of 34 patients experienced ≥ 1 early complication. Of 34 patients, 15 (44%) reported ≥ 1 late complications (>90 days). Most (85% and 69%, respectively) early and late complications were graded as minor (grade II or less). Fewer patients with early complications required an additional intervention (grade III) compared with patients with late complications (14% vs 31%; P = .116). The most common complication in both intervals was infection, reported in 22% and 37% of patients with early and late complications, respectively. The continence data for 31 patients at a mean follow-up of 20.1 months (median 12.0) showed that all but 1 patient (97%) had daytime and nighttime continence.
  
  
  CONCLUSIONS
  Patients undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction have comparable complication rates and functional outcomes compared with patients in the open series.
authors.affiliation: Department of Urologic Oncology, City of Hope Cancer Center, Duarte, California 91010-3000, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Torrey
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Chan
authors.forename: Wesley
authors.initials: W
authors.lastname: Yip
authors.forename: David Y
authors.initials: DY
authors.lastname: Josephson
authors.forename: Clayton S
authors.initials: CS
authors.lastname: Lau
authors.forename: Nora H
authors.initials: NH
authors.lastname: Ruel
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects*; D053207:Diurnal Enuresis / Q000209:etiology; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology; D006801:Humans; D007080:Ileocecal Valve / Q000601:surgery; D007239:Infections / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D053206:Nocturnal Enuresis / Q000209:etiology; D012371:Robotics; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects* / Q000379:methods