title: Robotic Intracorporeal Orthotopic Neobladder: Urodynamic Outcomes, Urinary Function, and Health-related Quality of Life.
abstract: BACKGROUND
  Intracorporeal orthotopic neobladder (iONB) creation following robotic radical cystectomy is an emerging procedure and robust functional data are required.
  
  
  OBJECTIVE
  To evaluate urodynamic features of iONB and bladder cancer-specific and general health-related quality-of-life (HRQOL) outcomes.
  
  
  METHODS
  We retrospectively assessed 28 men who underwent iONB creation (January 2012 to October 2013) and compared results to a previously characterized cohort of 79 of open ONB procedures.
  
  
  METHODS
  iONB pressure-volume properties were characterized using multichannel urodynamics (UDS). The Bladder Cancer Index (BCI) questionnaire, modified with mucus- and pad-related questions, and the Short Form Health Survey (SF-36) were used to evaluate urinary function and HRQOL. ONB cohorts were compared for functional outcomes and BCI score. Multivariable linear regression was used to assess predictors of BCI score.
  
  
  CONCLUSIONS
  The median follow-up was 9.4 mo for the iONB and 62.1 mo for the open ONB group (p<0.0001); ≥2-yr follow-up had been completed for one (4%) patient in the iONB group compared to 75 (95%) patients in the open ONB group (p<0.0001). In UDS tests, the iONB group had minimal postvoid residual volume, normal compliance, and a mean capacity of 514 cm(3) (range 339-1001). BCI mean scores for urinary function (p=0.58) and urinary bother (p=0.31) were comparable between the groups. The surgical approach was not associated with the BCI score on multivariable analysis. Rates of 24-h pad use were comparable between iONB and open ONB groups (pad-free 17% vs. 19%; ≤2 pads 84% vs. 79%), as reflected by total pad usage (p=0.1); pad size and daytime wetness were worse in the iONB group. The clean intermittent catheterization rate was 10.7% in the iONB and 6.3% in the open ONB group. Limitations include the retrospective comparison, small number of patients and short follow-up for the iONB group.
  
  
  CONCLUSIONS
  iONB had adequate UDS characteristics and comparable bladder cancer-specific HRQOL scores to open ONB. However, pad size and daytime wetness were worse for iONB, albeit over significantly shorter follow-up.
  
  
  RESULTS
  We demonstrate that the volumetric and pressure characteristics are acceptable for a neobladder created using an entirely robot-assisted laparoscopic technique after bladder removal for cancer. Urinary function and quality-of-life outcomes related to the robotic technique were compared to those for neobladders created via an open surgical technique. We found that urinary function and bother indices were comparable; however, the robotic group required larger incontinence pads that were wetter during the daytime. This may be explained by the significantly shorter duration of recovery after surgery in the robotic group.
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Satkunasivam
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Santomauro
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Plotner
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Cai
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Gus
authors.initials: G
authors.lastname: Miranda
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Salpi
authors.initials: S
authors.lastname: Salibian
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ginsberg
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
authors.affiliation: USC Institute of Urology and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: gillindy@gmail.com.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003187:Compliance; D015653:Cystectomy; D006801:Humans; D016496:Incontinence Pads; D057928:Intermittent Urethral Catheterization; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011788:Quality of Life; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D019738:Surgically-Created Structures / Q000009:adverse effects / Q000473:pathology* / Q000502:physiology*; D001743:Urinary Bladder / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D014554:Urination; D014563:Urodynamics
keywords: Functional outcomes; Health-related quality of life; Incontinence; Intracorporeal orthotopic neobladder; Orthotopic neobladder; Radical cystectomy; Robot-assisted radical cystectomy; Urodynamics; Urothelial cancer