Abstract Purpose: Functional outcomes of robot-assisted (RA) radical cystectomy (RC) with intracorporeal orthotopic neobladder (i-ON) have been poorly investigated. The study aimed to report functional outcomes of a prospective randomized controlled trial (RCT) comparing open RC (ORC) and RARC with i-ON. Methods: Inclusion criteria were cT2-4/N0/M0, or BCG-failure high-grade urothelial carcinoma, candidate to RC with curative intent. A covariate adaptive randomization process was used, based on the following variables: BMI, ASA score, haemoglobin levels, cT-stage, neoadjuvant chemotherapy, urinary diversion. Day-time continence was defined as "totally dryness", nigh-time continence as pad wetness ≤ 50 cc. Continence recovery probabilities were compared between arms with Kaplan-Meier method and Cox regression analysis was performed to identify predictors of continence recovery. HRQoL outcomes analysis was assessed with a generalized linear mixed effect regression (GLMER) model. Results: Out of 116 patients randomized, 88 received ON. Quantitative analysis of functional outcomes reported similar results in terms of day continence, while a better night continence status in ORC cohort was observed. However, 1-yr day- and night-time continence recovery probabilities were comparable. Night-time micturition frequency < 3 h was the only predictor of nigh-time continence recovery. At GLMER, 1-yr body image and sexual functioning were significantly better in RARC cohort, while urinary symptoms were comparable between arms. Conclusion: Despite superiority of ORC at quantitative night-time pad use analysis, we showed comparable day- and night-time continence recovery probabilities. At 1-yr analysis of HRQoL outcomes, urinary symptoms were comparable between arms, while RARC patients reported lower body image and sexual functioning worsening.

Open vs robotic intracorporeal Padua ileal bladder: functional outcomes of a single-centre RCT / Mastroianni, Riccardo; Tuderti, Gabriele; Ferriero, Mariaconsiglia; Anceschi, Umberto; Maria Bove, Alfredo; Brassetti, Aldo; Misuraca, Leonardo; Zampa, Ashanti; Torregiani, Giulia; Covotta, Marco; Guaglianone, Salvatore; Gallucci, Michele; Simone, Giuseppe. - In: WORLD JOURNAL OF UROLOGY. - ISSN 1433-8726. - (2023). [10.1007/s00345-023-04312-3]

Open vs robotic intracorporeal Padua ileal bladder: functional outcomes of a single-centre RCT

Riccardo Mastroianni;Gabriele Tuderti;Umberto Anceschi;Aldo Brassetti;Leonardo Misuraca;Giulia Torregiani;Marco Covotta;Michele Gallucci;
2023

Abstract

Abstract Purpose: Functional outcomes of robot-assisted (RA) radical cystectomy (RC) with intracorporeal orthotopic neobladder (i-ON) have been poorly investigated. The study aimed to report functional outcomes of a prospective randomized controlled trial (RCT) comparing open RC (ORC) and RARC with i-ON. Methods: Inclusion criteria were cT2-4/N0/M0, or BCG-failure high-grade urothelial carcinoma, candidate to RC with curative intent. A covariate adaptive randomization process was used, based on the following variables: BMI, ASA score, haemoglobin levels, cT-stage, neoadjuvant chemotherapy, urinary diversion. Day-time continence was defined as "totally dryness", nigh-time continence as pad wetness ≤ 50 cc. Continence recovery probabilities were compared between arms with Kaplan-Meier method and Cox regression analysis was performed to identify predictors of continence recovery. HRQoL outcomes analysis was assessed with a generalized linear mixed effect regression (GLMER) model. Results: Out of 116 patients randomized, 88 received ON. Quantitative analysis of functional outcomes reported similar results in terms of day continence, while a better night continence status in ORC cohort was observed. However, 1-yr day- and night-time continence recovery probabilities were comparable. Night-time micturition frequency < 3 h was the only predictor of nigh-time continence recovery. At GLMER, 1-yr body image and sexual functioning were significantly better in RARC cohort, while urinary symptoms were comparable between arms. Conclusion: Despite superiority of ORC at quantitative night-time pad use analysis, we showed comparable day- and night-time continence recovery probabilities. At 1-yr analysis of HRQoL outcomes, urinary symptoms were comparable between arms, while RARC patients reported lower body image and sexual functioning worsening.
2023
Functional outcomes; Open surgery; Orthotopic neobladders; Radical cystectomy; Randomized controlled trial; Robotic surgery; Urinary continence
01 Pubblicazione su rivista::01a Articolo in rivista
Open vs robotic intracorporeal Padua ileal bladder: functional outcomes of a single-centre RCT / Mastroianni, Riccardo; Tuderti, Gabriele; Ferriero, Mariaconsiglia; Anceschi, Umberto; Maria Bove, Alfredo; Brassetti, Aldo; Misuraca, Leonardo; Zampa, Ashanti; Torregiani, Giulia; Covotta, Marco; Guaglianone, Salvatore; Gallucci, Michele; Simone, Giuseppe. - In: WORLD JOURNAL OF UROLOGY. - ISSN 1433-8726. - (2023). [10.1007/s00345-023-04312-3]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1692733
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