Kraft Pia, Schregel Christoph, Obrecht Fabian, Foerster Beat, Froelicher Gabriel, Burkhardt Orlando, Boehler Katharina, Padevit Christian, Tornic Jure, Wiklund Peter, John Hubert
Department of Urology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
Department of Urology, Karolinska Institute, Stockholm, Sweden.
World J Urol. 2025 Jul 16;43(1):437. doi: 10.1007/s00345-025-05821-z.
Robotic-assisted radical cystectomy (RARC) with complete intracorporeal orthotopic neobladder offers a less invasive reconstruction of continent urinary diversion to the open approach. The aim was to evaluate long-term functional, urodynamic, and metabolic outcomes after RARC with intracorporeal orthotopic neobladder.
In this retrospective study, 18 consecutive patients (16 men, median age 67 years) undergoing RARC for urothelial carcinoma with intracorporeal orthotopic neobladder between November 2015 and May 2021 were included. Video urodynamic evaluations assessed neobladder capacity, pressure at maximum filling, ureteral reflux and post-void residual volume. Continence was evaluated by questionnaires and pad count. Laboratory values were retrieved from the clinic information system. A subgroup of patients underwent both early and a late with video urodynamic studies were performed.
Median time between RARC with intracorporeal orthotopic neobladder reconstruction and late postoperative studies was 60 months. Urodynamic measurements showed a median maximum neobladder capacity of 485 mL (interquartile range (IQR), 433-625) and a maximum neobladder pressure of 20 cmHO (IQR, 11-25). The daytime continence rate (≤ 1 pad) was 89% (16/18 patients), while the nighttime rate was 61% (11/18 patients). Intermittent self-catheterization was needed in 28%. Bicarbonate substitution was required in 22% (4/18) of patients. In 50% (9/18) of patients with an additional early postoperative study after 11 months, urodynamic, functional, and metabolic changes were stable between early and late studies (all, p > 0.05).
This patient series reports comprehensive long term urodynamic, functional, and metabolic results five years after RARC with intracorporeal orthotopic neobladder reconstruction. In a subgroup analysis, neobladder function, renal function, and metabolic status remained stable between early and late postoperative assessments, which may indicate favorable long-term outcomes.
机器人辅助根治性膀胱切除术（RARC）联合完全体内原位新膀胱术为开放性手术提供了一种侵入性较小的可控性尿流改道重建方式。本研究旨在评估RARC联合体内原位新膀胱术后的长期功能、尿动力学和代谢结果。
在这项回顾性研究中，纳入了2015年11月至2021年5月期间连续18例（16例男性，中位年龄67岁）因尿路上皮癌接受RARC联合体内原位新膀胱术的患者。视频尿动力学评估包括新膀胱容量、最大充盈时压力、输尿管反流和排尿后残余尿量。通过问卷调查和尿垫计数评估控尿情况。从临床信息系统获取实验室检查值。对部分患者在术后早期和晚期均进行了视频尿动力学研究。
RARC联合体内原位新膀胱重建术至术后晚期研究的中位时间为60个月。尿动力学测量显示，新膀胱中位最大容量为485 mL（四分位间距（IQR），433 - 625），新膀胱最大压力为20 cmH₂O（IQR，11 - 25）。白天控尿率（≤1片尿垫）为89%（16/18例患者），夜间控尿率为61%（11/18例患者）。28%的患者需要间歇性自我导尿。22%（4/18）的患者需要补充碳酸氢盐。在术后11个月进行了额外早期研究的患者中，50%（9/18）的患者在早期和晚期研究之间尿动力学、功能和代谢变化稳定（所有p>0.05）。
本患者系列报告了RARC联合体内原位新膀胱重建术后五年全面的长期尿动力学、功能和代谢结果。在亚组分析中，术后早期和晚期评估之间新膀胱功能、肾功能和代谢状态保持稳定，这可能表明长期预后良好。
