Long-term functional outcomes and complications of robot-assisted laparoscopic supratrigonal cystectomy with augmentation cystoplasty in adult patients with neurogenic lower urinary tract dysfunction and interstitial cystitis/bladder pain syndrome: A single-centre experience

Abstract

Objectives

To report the long-term functional outcomes and complications of robot-assisted laparoscopic supratrigonal cystectomy with augmentation cystoplasty (RA-SC-AC) in adult patients with neurogenic lower urinary tract dysfunction (NLUTD) or Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS).

Materials and Methods

We retrospectively analysed the records of adult patients who underwent RA-SC-AC at our institution between 2012 and 2020. Patients with NLUTD had refractory neurogenic detrusor overactivity or poor bladder compliance; patients with IC/BPS presented with severe pain and/or reduced bladder capacity (<400 ml). Our centre is a national referral institution for advanced BPS/IC. We recorded early and late complications, urodynamic parameters, pain scores, continence status and quality of life (Patient Global Impression of Improvement, PGI-I). We also report how many patients eventually required self-catheterization.

Results

Seventy-one patients were included (41 NLUTD, 30 IC/BPS); the median follow-up was 4.8 years ± 2.2. Overall, 36.7% experienced early (<30 days) complications, mostly minor (Clavien ≤2). Three major late complications occurred (one bladder perforation, two bowel obstructions). Among NLUTD patients, 90.2% achieved a low-pressure reservoir, and the continence rate rose from 48.0% preoperatively to 92.7%. In IC/BPS, pain scores significantly decreased (7.8 ± 2.0 to 2.2 ± 0.4; p < 0.001) and maximum cystometric capacity increased (112 ± 39 ml to 304 ± 54 ml; p < 0.001). Four patients (13.3%) were surgical failures, persisting with severe symptoms. Eleven patients (36.7%) required de novo intermittent self-catheterization.

Overall, 73.0% reported improved quality of life at last follow-up.

Conclusions

RA-SC-AC is feasible, with acceptable morbidity and long-term functional benefits in both NLUTD and IC/BPS patients failing conservative treatments. Most patients experienced significantly improved bladder function and pain relief, as well as an enhanced quality of life.