Robotic Cystectomy Proves Effective for Patients with NLUTD and Bladder Pain

Recent research indicates that a robot-assisted approach to laparoscopic supratrigonal cystectomy combined with augmentation cystoplasty is a viable option for adults suffering from neurogenic lower urinary tract dysfunction (NLUTD) and interstitial cystitis/bladder pain syndrome (IC/BPS). This study, featured in the July edition of BJUI Compass, highlights significant long-term functional outcomes and overall patient safety.

The research team from Nantes Université in France undertook a retrospective analysis involving 71 patients who underwent this robotic surgical procedure between 2012 and 2020. This patient group comprised 41 individuals with NLUTD and 30 with IC/BPS, who were monitored for an average duration of 4.8 years.

The findings revealed that approximately 36.7% of patients experienced early complications, primarily classified as minor (Clavien grade <=2). Notably, three major complications were recorded, including one incident of bladder perforation and two cases of bowel obstruction. On a positive note, 90.2% of patients with NLUTD achieved a low-pressure bladder reservoir following the surgery, and the continence rate showed a remarkable increase from 48% pre-operation to 92.7% post-operation.

Furthermore, patients suffering from IC/BPS reported a significant reduction in pain levels, with scores dropping from an average of 7.8 to 2.2 on a standard pain scale. Additionally, the maximum cystometric capacity surged from 112 mL to 304 mL, indicating improved bladder functionality.

While the study noted that surgical failures occurred in 13.3% of cases, where patients continued to experience severe symptoms, the requirement for de novo intermittent catheterization was observed in 36.7% of the participants.

The authors of the study conclude that their results demonstrate durable improvements in bladder capacity, pain management, and continence, with complication rates remaining within acceptable limits. They suggest that future controlled or randomized studies are necessary to further clarify the specific advantages of the robotic surgical approach and to enhance patient selection criteria, particularly within complex referral-based populations.

It is worth noting that two authors of the study have disclosed financial ties to Intuitive Surgical, the manufacturer of robotic surgical systems.

For further reading, refer to the original research by Thomas Batard et al., published in BJUI Compass.