Robot assisted cystectomy (RAC) is well established in the management of muscle invasive or high-grade non-muscle invasive bladder cancer. There are very few reports on its application for benign disease. We report on outcomes, adverse events and discuss the influence of aetiology on these parameters.

Single centre, retrospective review. Patients underwent benign RAC between 2013—2024. Data was collected from a prospectively maintained cystectomy database and electronic health records. Statistical analysis was carried out on R including descriptive statistics, t-test, Fisher’s exact test, Mann-Whitney U test.

70 patients with mean age 65 (23-96) underwent RAC. Indications included radiation cystitis N=34 (48.6%), other cystitis N=14 (20%), premalignant changes N=9 (12.9%), refractory overactive bladder N=8 (11.4%), neurogenic bladder N=4 (5.7%), and Fowler’s syndrome N=1 (1.4%). Intracorporeal ileal conduit diversion was performed in N=57 (81%). Mean operating time was 334 minutes (180-540). Intraoperative blood loss was 326ml (100-1250) in the radiation group and 300ml (range 100-800) in the remainder. Mean follow-up was 16 months (1-58); There was no significant postoperative deterioration in renal function at 1 year in either group (p = 0.8). Complications within 90d were recorded in 46 patients (66%). Of these, 67% were Clavien II. There were 15 (21%) readmissions within 30 days, predominantly for acute kidney injury and sepsis; of those 8 (11%) patients underwent further interventions. Limitations include the retrospective nature of the study.

RAC is safe and feasible for benign disease. Benefits and complication rates appear to be equivalent to those requiring radical surgery for malignancy.

This study provides insights into the application of robot-assisted cystectomy (RAC) for benign bladder conditions, and to date is the largest published series on RAC for radiation cystitis.
The findings demonstrate that RAC is a safe and feasible option for benign indications, with complication rates comparable to those observed in malignant cases. These results suggest that RAC can be effectively utilised for benign bladder disease with acceptable safety and efficacy.