Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence

Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time con...

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Main Authors: Federico Mineo Bianchi, Daniele Romagnoli, Daniele D'Agostino, Antonio Salvaggio, Marco Giampaoli, Paolo Corsi, Lorenzo Bianchi, Marco Borghesi, Riccardo Schiavina, Eugenio Brunocilla, Peter Wiklund, Angelo Porreca
Format: Article
Language:English
Published: PAGEPress Publications 2019-03-01
Series:Archivio Italiano di Urologia e Andrologia
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Online Access:https://www.pagepressjournals.org/index.php/aiua/article/view/8028
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spelling doaj-18a8be4e28d94eef9fed7af25e7ee0042020-11-25T03:50:55ZengPAGEPress PublicationsArchivio Italiano di Urologia e Andrologia1124-35622282-41972019-03-0191110.4081/aiua.2019.1.5Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continenceFederico Mineo Bianchi0Daniele Romagnoli1Daniele D'Agostino2Antonio Salvaggio3Marco Giampaoli4Paolo Corsi5Lorenzo Bianchi6Marco Borghesi7Riccardo Schiavina8Eugenio Brunocilla9Peter Wiklund10Angelo Porreca11Department of Urology, Policlinic of Abano Terme (Padova); Department of Urology, S. Orsola-Malpighi Hospital, University of BolognaDepartment of Urology, Policlinic of Abano Terme (Padova)Department of Urology, Policlinic of Abano Terme (Padova)Department of Urology, Policlinic of Abano Terme (Padova)Department of Urology, Policlinic of Abano Terme (Padova)Department of Urology, Policlinic of Abano Terme (Padova)Department of Urology, Policlinic of Abano Terme (Padova)Department of Urology, S. Orsola-Malpighi Hospital, University of BolognaDepartment of Urology, S. Orsola-Malpighi Hospital, University of BolognaDepartment of Urology, S. Orsola-Malpighi Hospital, University of BolognaDepartment of Urology, Mount Sinai Institution, Icahn School of Medicine, New York City, NYDepartment of Urology, Policlinic of Abano Terme (Padova) Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time continence recovery during a 12-month follow up. Materials and methods: We prospectively collected data from 42 consecutive patients who underwent RARC with totally intracorporeal ON and extended pelvic lymph node dissection (PLND) at our Institution from June 2014 to October 2017. Prior to the urethro-neobladder anastomosis we reconstructed the Denonvilliers Fascia (DF) as previously described for radical prostatectomy using a bidirectional barbed suture. Day and night-time recovery rates were reported at 3, 6 and 12 months after surgery, with continent patients being those using either no urinary pads or 1 safety pads. Results: Median age at surgery was 63 yrs, 41 (97.6%) patients were male. 28 (66.7%) patients presented a clinical T2 disease. Median operative time and median ON reconstruction time were 450 minutes and 180 minutes respectively. 13 (31%) individuals had non-organ confined disease, with 11 (26.2%) patients with positive lymph nodes (median 3 positive lymph nodes) and 2 (4.8%) with non-urothelial cancer at final pathologic examination. Median hospital stay and median catheterization time were 7 (IQR 7-8) and 21 (IQR 19-22). During first 30 post-operative days we recorded 7 (16.7%) low-grade Clavien and 2 (4.8%) IIIa Clavien complications, whereas between 30 and 90 postoperative days we recorded 4 (9.5%) low-grade, 4 (9.5) IIIa and 1 (2.4%) IIIb complications. Day-time and night-time continence rates were 61.9% vs 52.4%, 73.8% vs 64.3% and 90.5% vs 73.8% at three, six and twelve months follow up. Day-time continence was significantly superior in the younger group (97% vs 57%, p 0.01); night-time continence rates were also superior among < 70 yrs patients, despite not reaching statistical significance (77% vs 57%, p 0.3). Conclusions: Posterior muscle-fascial reconstruction aids continence recovery in BC patients undergoing RARC with ON, with younger and fitter patients most benefitting from ON reconstruction. https://www.pagepressjournals.org/index.php/aiua/article/view/8028robotic radical cystectomyorthotopic neobladderposterior muscolkofascial reconstructionradical cystectomyrobotic surgery
collection DOAJ
language English
format Article
sources DOAJ
author Federico Mineo Bianchi
Daniele Romagnoli
Daniele D'Agostino
Antonio Salvaggio
Marco Giampaoli
Paolo Corsi
Lorenzo Bianchi
Marco Borghesi
Riccardo Schiavina
Eugenio Brunocilla
Peter Wiklund
Angelo Porreca
spellingShingle Federico Mineo Bianchi
Daniele Romagnoli
Daniele D'Agostino
Antonio Salvaggio
Marco Giampaoli
Paolo Corsi
Lorenzo Bianchi
Marco Borghesi
Riccardo Schiavina
Eugenio Brunocilla
Peter Wiklund
Angelo Porreca
Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
Archivio Italiano di Urologia e Andrologia
robotic radical cystectomy
orthotopic neobladder
posterior muscolkofascial reconstruction
radical cystectomy
robotic surgery
author_facet Federico Mineo Bianchi
Daniele Romagnoli
Daniele D'Agostino
Antonio Salvaggio
Marco Giampaoli
Paolo Corsi
Lorenzo Bianchi
Marco Borghesi
Riccardo Schiavina
Eugenio Brunocilla
Peter Wiklund
Angelo Porreca
author_sort Federico Mineo Bianchi
title Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
title_short Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
title_full Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
title_fullStr Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
title_full_unstemmed Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence
title_sort posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: description of the technique and its impact on urinary continence
publisher PAGEPress Publications
series Archivio Italiano di Urologia e Andrologia
issn 1124-3562
2282-4197
publishDate 2019-03-01
description Objective: The aim of our study is to describe the use of posterior muscle-fascial reconstruction during urethro-ileal anastomosis in bladder cancer (BC) patients submitted to robot-assisted radical cystectomy (RC) with orthotopic neobladder (ON) and its role in facilitating day- and night-time continence recovery during a 12-month follow up. Materials and methods: We prospectively collected data from 42 consecutive patients who underwent RARC with totally intracorporeal ON and extended pelvic lymph node dissection (PLND) at our Institution from June 2014 to October 2017. Prior to the urethro-neobladder anastomosis we reconstructed the Denonvilliers Fascia (DF) as previously described for radical prostatectomy using a bidirectional barbed suture. Day and night-time recovery rates were reported at 3, 6 and 12 months after surgery, with continent patients being those using either no urinary pads or 1 safety pads. Results: Median age at surgery was 63 yrs, 41 (97.6%) patients were male. 28 (66.7%) patients presented a clinical T2 disease. Median operative time and median ON reconstruction time were 450 minutes and 180 minutes respectively. 13 (31%) individuals had non-organ confined disease, with 11 (26.2%) patients with positive lymph nodes (median 3 positive lymph nodes) and 2 (4.8%) with non-urothelial cancer at final pathologic examination. Median hospital stay and median catheterization time were 7 (IQR 7-8) and 21 (IQR 19-22). During first 30 post-operative days we recorded 7 (16.7%) low-grade Clavien and 2 (4.8%) IIIa Clavien complications, whereas between 30 and 90 postoperative days we recorded 4 (9.5%) low-grade, 4 (9.5) IIIa and 1 (2.4%) IIIb complications. Day-time and night-time continence rates were 61.9% vs 52.4%, 73.8% vs 64.3% and 90.5% vs 73.8% at three, six and twelve months follow up. Day-time continence was significantly superior in the younger group (97% vs 57%, p 0.01); night-time continence rates were also superior among < 70 yrs patients, despite not reaching statistical significance (77% vs 57%, p 0.3). Conclusions: Posterior muscle-fascial reconstruction aids continence recovery in BC patients undergoing RARC with ON, with younger and fitter patients most benefitting from ON reconstruction.
topic robotic radical cystectomy
orthotopic neobladder
posterior muscolkofascial reconstruction
radical cystectomy
robotic surgery
url https://www.pagepressjournals.org/index.php/aiua/article/view/8028
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