Long-term outcomes in patients with intracorporeal robot-assisted pyramid neobladder

IF 1.9 Q3 UROLOGY & NEPHROLOGY

BJUI compass Pub Date : 2025-08-11 DOI:10.1002/bco2.70062

Elizabeth Day, Pratham Upadhyay, Raashi Padhiyar, Lazaros Tzelves, Bernadett Szabados, Anthony Ta, Ashwin Sridhar, John Kelly

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Abstract

Objectives

A range of techniques have been described for robotic-assisted intracorporeal neobladder construction. The pyramid neobladder has now been performed for over 10 years. We now describe the long-term outcomes, including the impact of function preservation through nerve and prostate capsule sparing in the male population.

Subjects/Patients and Methods

All patients who underwent pyramid neobladder construction between January 2015 and December 2023 at the University College London Hospital (UK) were reviewed. Patients were selected for function preservation based on baseline sexual function/wishes, PSA ± multiparametric prostate MRI. Selected oncological, functional and patient reported outcomes were assessed.

Results

A total of 71 patients were included; 87% (61/71) were men. About 65% (40/61) underwent either nerve- or prostate capsule-sparing surgery. Median follow-up was 57.8 months (IQR 48.3). In male patients, there was no difference between the 12- and 24-month cancer specific and overall survival rates between the function sparing groups. There were no positive prostate cancer margins. Daytime continence was 75% (39/52) and 67% (6/9), and nighttime was 17% (9/52) and 11% (1/9), in men and women, respectively. There was no significant difference between the male function sparing groups (p < 0.342). About 94% of men (29/31) were sexually active before surgery, falling to 55% (17/31) after, with 76% (13/17) using treatment for erectile dysfunction. The median change in SHIM score was 4.5 (SD 5.3) in prostate capsule-sparing, 6 (SD 7.7) in nerve-sparing and 17 (SD 2.8) in standard groups.

About 45% (30/66) of patients had a significant reduction in eGFR (>10 mL/min/1.73m²). Uretero–ileal strictures were confirmed in 4.2% (3/71). About 28% (19/67) of patients reported recurrent UTIs and 7% (5/71) reported neobladder rupture.

Conclusion

Sexual function had the largest impact on quality of life and may be improved with function-sparing techniques. The burden of additional complications including neobladder rupture and urinary tract infections was also highlighted.

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体内机器人辅助锥形新膀胱患者的长期预后

目的：机器人辅助体内新膀胱构建的一系列技术已经被描述。金字塔新膀胱手术已经进行了10多年。我们现在描述了长期结果，包括通过男性人群的神经和前列腺包膜保留功能的影响。研究对象/患者和方法回顾了2015年1月至2023年12月在英国伦敦大学学院医院（University College London Hospital）接受金字塔状新膀胱建造的所有患者。根据基线性功能/愿望、PSA±多参数前列腺MRI选择患者进行功能保存。评估选定的肿瘤、功能和患者报告的结果。结果共纳入71例患者；87%（61/71）为男性。约65%（40/61）的患者接受了保留神经或前列腺包膜的手术。中位随访时间为57.8个月（IQR为48.3）。在男性患者中，功能保留组之间12个月和24个月的癌症特异性生存率和总生存率没有差异。前列腺癌边缘未见阳性。男性和女性白天禁尿率分别为75%（39/52）和67%(6/9)，夜间禁尿率分别为17%（9/52）和11%（1/9）。男性功能保留组间差异无统计学意义（p < 0.342）。约94%的男性（29/31）在手术前性活跃，手术后降至55%(17/31)，其中76%（13/17）接受了勃起功能障碍治疗。前列腺包膜保留组SHIM评分的中位变化为4.5 (SD 5.3)，神经保留组为6 (SD 7.7)，标准组为17 （SD 2.8）。约45%（30/66）的患者eGFR显著降低（10 mL/min/1.73m2）。4.2%（3/71）确认输尿管-回肠狭窄。约28%（19/67）的患者报告尿路感染复发，7%（5/71）的患者报告新膀胱破裂。结论对生活质量影响最大的是性功能，可通过功能保留技术加以改善。其他并发症的负担，包括新膀胱破裂和尿路感染也被强调。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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