Robot-assisted laparoscopic continent cutaneous urinary diversion in a single- center study; surgical technique and outcomes

Abstract Introduction: Robot assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) has been shown to be feasible; however, data on clinical outcomes in adults are lacking. Materials & Methods: We conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference center. Participant characteristics, clinical information and perioperative outcomes were recorded. All participants underwent pre and postoperative urodynamic evaluations. Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage. Results: Twelve patients, mostly women (n=11), median (IQR) age 47.4 (19-57) years underwent RALCCUD (4 Mitrofanoff, 4 Yang-Monti and 4 Casale). The main indication for surgery was inability to perform intermittent self-catheterization through the native urethra. Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism. Median (IQR) operative time was 313 (285-367) min. Four patients (33%) underwent concomitant procedures: 3 supra-trigonal cystectomy with augmentation cystoplasty and 1 artificial urinary sphincter. No conversions to an open approach were required. Median (IQR) follow-up was 42.9 (34-53) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with 3 complications occurring in 2 patients. At the last follow up, all patients could self-catheterize through the tube, and the stomal and urethral continence rate was 100%. Conclusion: RALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.