Robotic intracorporeal Padua ileal neobladder vs Florin pouch: head to head comparison of early urodynamic and functional profiles at two high-volume centres

Anceschi U1, Fede Spicchiale C2, Mari A3, Brassetti A1, Tuderti G1, Ferriero M1, Misuraca L1, Mastroianni R1, Pastore S2, Amato I2, Mattioli M4, Fuschi A5, Finazzi Agrò E2, De Nunzio C4, Pastore A5, Gallucci M1, Carini M3, Minervini A3, Simone G1

Research Type

Clinical

Abstract Category

Urodynamics

Abstract 8
Live Urology 1 - Surgical Insights
Scientific Podium Session 1
Thursday 14th October 2021
09:10 - 09:20
Live Room 1
Urodynamics Techniques Robotic-assisted genitourinary reconstruction Incontinence
1. “Regina Elena” National Cancer Institute – Department of Urologic Oncology, 2. “Policlinico Tor Vergata” – University of Rome – Department of Urology, 3. “AOU Careggi” – University of Florence – Department of Urology, 4. “Policlinico S. Andrea” – University of Rome -Department of Urology, 5. “ICOT Latina – Polo Pontino – La Sapienza – University of Rome – Department of Urology
Presenter
C

Claudia Fede Spicchiale

Links

Abstract

Hypothesis / aims of study
In recent years, several intracorporeal orthotopic neobladders (iONBs) reconstructions after robotic radical cystectomy (RARC) using intestinal segments with detubularised ileum have been described. However, robust functional data comparing different robotic iONBs techniques are currently missing. The aim of this series was to compare the early urodynamic and functional outcomes of Padua (PIN) and Florin iONBs performed at two high-volume centres.
Study design, materials and methods
Between June 2017 and December 2020 two prospective, board-approved, radical cystectomy datasets were matched and queried for “urodynamic evaluation”, “robotic Florin neobladder” (Group A; n=23), “robotic Padua Ileal neobladder” (Group B; n=24). Complete urodynamic profile including uroflowmetry, cystometry, compliance, presence of residual peristaltic activity, abdominal leak point pressure (ALPP) as functional outcomes assessed by daytime and night-time continence (defined as the use of 0-1 pad) and stress incontinence rates were compared between groups. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Differences between continuous variables were assessed with t test, while Pearson’s χ2 test was used for categorical data. For all analyses, a two-sided p<0.05 was considered significant.
Results
Overall, at a median follow-up of 8 months (IQR 7-15) 47 patients achieved a complete urodynamic evaluation (Table 1). In the group A patients were older (67 vs 61; p=0.03) with a shorter follow-up (7 vs 13; p=0.01). Compared to PIN, Florin pouch showed a lower cystometric capacity (260  vs 302 cc) and compliance (15.7 vs 10 cmH20) (each p<0.05). The rate of neobladder residual peristaltic activity, end-filling pressure, maximal flow rate, and postvoid residual urine volume were comparable between groups (each p>0.05). The ALPP was significantly increased in the PIN cohort (90 vs 60 cmH20; p=0.036) while the stress urinary incontinence rate was comparable between groups (p=0.608). In the Florin series the daytime and night-time continence rates were 82.6% and 50% while in the PIN series were 75% and 50%, respectively (each p>0.5; Table 2). PIN showed a later onset of night-time urinary continence (6 vs 3 months) and an increased rate of clean intermittent catheterization (16.7 vs 4.3%) (each p<0.03)
Interpretation of results
Basing on our data, Florin pouch appeared to reach a lower cystometric capacity and compliance than PIN; on the other hand, PIN showed a later onset of night-time continence and an increased rate of CIC. However, no significant differences were found for other urodynamic parameters such as neobladder residual peristaltic activity, end-filling pressure, maximal flow rate and PVR. In particular, continence rates were comparable, and so were the stress urinary incontinence rates, showing no superiority of one neobladder on the other.
Concluding message
Florin pouch and PIN achieved excellent continence rates at an early follow-up. Technical nuances of ileal detubularisation and folding may explain the disparity between Florin and PIN in terms of cystometric capacity and compliance. The  urodynamic and functional results obtained support both iONBs as a safe option comparable to their open counterpart after RARC
Figure 1 Early urodynamic assessment profile of Florin pouch and PIN
Figure 2 Early functional assessment of Florin Pouch and PIN
References
  1. Benamran D, Phé V, Drouin SJ et al; Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review. J Robot Surg. 2020 Dec;14(6):813-820.
  2. Simone G, Papalia R, Misuraca L et al Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. Eur Urol. 2018 Jun;73(6):934-940
  3. Minervini A, Vanacore D, Vittori G, et al; Florence robotic intracorporeal neobladder (FloRIN): a new reconfiguration strategy developed following the IDEAL guidelines. BJU Int. 2018 Feb;121(2):313-317
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd It was a retrospective study Helsinki Yes Informed Consent Yes
01/06/2022 07:35:35