Intracorporeal urinary diversion during robot-assisted radical cystectomy using indocyanine green

INTRODUCTION To describe the feasibility of total intracorporeal urinary diversion during robotic assisted radical cystectomy using indocyanine green (ICG) and the Firefly system of the da Vinci Xi robot and to evaluate the digestive and urinary outcomes of this technique.

MATERIALS AND METHODS

After approval by the Institutional Review Board, we studied all consecutive patients who underwent robotic assisted radical cystectomy (RARC) and intracorporeal urinary derivation (ICUD) with the da Vinci Xi robot using ICG and the Firefly system, in our institution from January 1st 2018 to September 15th 2018. Pre, intra and postoperative data were analyzed with a follow up of at least 1 month.

RESULTS

We included 25 patients. Preoperative data were the following: 92 % were men, median age was 74 years (IQR 69-76), 64% of patients had an ASA score ≥ 3. Median operative time was 390 min (IQR 360-460). Median return to bowel function was 3 days for gas (IQR 2-5) and 5 days for stool (IQR 3-6). Median length of hospital stay was 8 days (IQR 7-10). After a median follow up of 9.6 months (IQR 8.3-12.5), only one patient (4%) presented with postoperative obstructive syndrome. There were 2 (8%) urinary leaks and 1 (4%) uretrero-enteric stricture. There were no digestive fistulas recorded. Eleven patients (44%) were readmitted within 90 days for complications.

CONCLUSIONS

Total intracorporeal urinary diversion during robotic assisted radical cystectomy using ICG is a feasible technique that might reduce return of bowel function and with low urinary and digestive complications.

Factors affecting guideline adherence in the initial treatment of non-muscle invasive bladder cancer: Retrospective study in a French peripheral hospital

OBJECTIVES

To assess whether the initial treatment of non-muscle invasive bladder cancer (NMIBC) was performed according to the guidelines, and to determine the reasons why initial treatment was not provided in nonadherence cases.

MATERIALS AND METHODS

We retrospectively reviewed all patients with NMIBC who underwent their first transurethral resection of bladder tumor (TURBT) at a peripheral hospital, between 2007 and 2016. The treatment offered to the patient was compared to the European Association of Urology guidelines according to risk stratification. For each patient who did not receive the treatment according to the guidelines, one of the following reasons was identified: poor patient compliance, poor patient general health status, urologist's decision, lack of resources.

RESULTS

One hundred fifty-nine patients were included with a mean age of 72.2 years at the time of NMIBC diagnosis. The low-risk patients were strictly treated according to the guidelines. Among the intermediate-risk patients, 14% received mitomycin C. Among the high-risk patients, 39% received intravesical Bacillus Calmette-Guerin. In the nonadherence cases (61%), the reasons were related to the patient in 44% of cases (poor compliance, 21%; poor patient general health status, 23%), urologist's decision in 54% of cases, and lack of resources in 2% of cases. Thirty-seven percent of the high-risk patients underwent re-resection.

CONCLUSIONS

Overall, adherence to NMIBC guidelines was low in all treatment types (intravesical therapy, re-resection, or cystectomy for very high-risk patients), but this finding was similar to that in previous studies. Reasons were mainly related to the urologist's decision or to the patient condition (poor compliance or poor general health status).

LEVEL OF EVIDENCE

3.