IMPACT OF TRANSVAGINAL SPECIMEN EXTRACTION ON URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY AND INTRACORPOREAL ORTHOTOPIC NEOBLADDER

INTRODUCTION AND OBJECTIVE: Robot-assisted Radical Cystectomy (RARC) with totally intracorporeal (i) orthotopic neobladder (ON) is progressively increasing. However, functional outcomes and their predictors are under-investigated, particularly in female patients. In the robotic era, transvaginal specimen extraction has become routinely performed. The aim of this study was to predict day- and night-time continence recovery in patients receiving RARC and i-ON. METHODS: Our single center IRB approved BCa database was queried for “RARC”, “female” and “iON”. Baseline demographic, clinical, perioperative and functional outcomes of all consecutive patients treated between Jan 2016 and Jul 2022 were collected. Patients receiving a sex-sparing approach were excluded, due to its established impact on functional outcomes. Continence status was evaluated trough 3-day voiding diaries; day-time continence was defined as “totally dryness” (0gr), night-time continence as pad wetness ≤50gr. Continence recovery probabilities were compared with Kaplan-Meier (KM) method and Cox regression analysis were performed to identify predictors of day-time and night-time continence recovery. RESULTS: Overall, 35 female patients were included. Baseline and perioperative outcomes were reported. Median age was 62 (IQR 55-66) and BMI was 24.5 (IQR 21.5-28.0). High-grade complications (Clavien ≥3) occurred in 11% of patients (Table 1). At KM analysis patients receiving a suprapubic incision for specimen extraction displayed significantly higher day-time continence recovery probabilities (log-rank p=0.013), while no differences were observed for nigh-time continence recovery between transvaginal and suprapubic cohorts (Figure 1-2). At cox-regression analysis, transvaginal specimen extraction predicted a 65% reduced probability of day-time continence recovery (HR 0,35 95% CI 0.14-0.89; p=0.03), while no impact was observed on night-time continence recovery probabilities (p=0.86) (Table 2). CONCLUSIONS: In this single center series, transvaginal specimen extraction seems to negatively affect day-time continence recovery, while night-time continence recovery remained unaltered by specimens extraction site. Larger multi-institutional cohorts and longer follow-up are needed to confirm these findings.