Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction

Rohit Bhatt; Dylan J Mittauer; Joel M Vetter; Nimrod S Barashi; Riley McGinnis; Kenneth G Sands; Alexander K Chow; Eric H Kim

doi:10.7759/cureus.56825

Comparing Bladder Neck Contracture Rate Between Robotic Intracorporeal and Extracorporeal Neobladder Construction

Cureus. 2024 Mar 24;16(3):e56825. doi: 10.7759/cureus.56825. eCollection 2024 Mar.

Authors

Rohit Bhatt¹, Dylan J Mittauer², Joel M Vetter², Nimrod S Barashi², Riley McGinnis², Kenneth G Sands², Alexander K Chow³, Eric H Kim²

Affiliations

¹ Department of Urology, University of California Irvine Health, Orange, USA.
² Department of Urology, Washington University School of Medicine, St. Louis, USA.
³ Department of Urology, Rush University Medical Center, Chicago, USA.

Abstract

Robot-assisted radical cystectomy (RARC) has become more accessible to surgeons worldwide, and descriptions of intracorporeal urinary diversion techniques, such as orthotopic neobladder construction, have increased. In this study, we aim to compare the rate of bladder neck contracture (BNC) formation between RARC and two different urinary diversion techniques. We retrospectively reviewed our institutional database for patients with bladder cancer who underwent RARC with intracorporeal neobladder (ICNB) construction (n = 11) or extracorporeal neobladder (ECNB) construction (n = 11) between 2012 and 2020. BNC was defined by the need for an additional surgical procedure (e.g., dilatation, urethrotomy). Patients who underwent RARC with ICNB (n = 11) were compared to patients who underwent RARC with ECNB (n = 11) across patient characteristics and postoperative BNC formation rates. Kaplan-Meier curves were generated for freedom from BNC based on the neobladder approach and compared with the log-rank test. For patients who received an ECNB, 73% (8/11) developed a BNC; in comparison, none of the patients in the ICNB group experienced a BNC. Kaplan-Meier survival analysis demonstrates the ECNB group's median probability of freedom from BNC as 1.3 years, while the ICNB group was free of BNC over the study period (p < 0.001). RARC with ICNB creation demonstrated a significantly reduced BNC rate in contrast to RARC with ECNB construction. Longer-term follow-up is needed to assess the durability of this difference in BNC rates.

Keywords: bladder neck contracture; extracorporeal neobladder construction; intracorporeal neobladder construction; robot-assisted radical cystectomy; urinary diversion.