Robot-assisted laparoscopic continent cutaneous urinary diversion in adults: A single-centre study

Abstract

Objectives

To show that robot-assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.

Materials and methods

We conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.

Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre- and postoperative urodynamic evaluations.

Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.

Results

Twelve patients, mostly women (n = 11), median (IQR) age 47.4 (19–57) years underwent RALCCUD (four Mitrofanoff, four Yang-Monti and four Casale). The main indication for surgery was inability to perform intermittent self-catheterization through the native urethra.

Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.

Median (IQR) operative time was 313 (285–367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow-up was 51 (40–61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.

At the last follow-up, all patients could self-catheterize through the tube, and the stomal and urethral continence rate was 100%.

Conclusion

RALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.