Totally intracorporeal ileal neobladder following robot-assisted radical cystectomy in male patients using the Juntendo technique: Initial experience.

Purpose: We developed a totally intracorporeal neobladder (ICNB) reconstruction technique, termed the Juntendo technique, which features a more spherical configuration by advancing from a hybrid neobladder reconstruction approach. In this report, we describe this ICNB procedure and its outcomes from our initial clinical experience.

Materials and methods: Between March 2022 and December 2024, 20 male patients underwent neobladder reconstruction (hybrid reconstruction in the first 10 and totally intracorporeal reconstruction in the other 10) following robot-assisted radical cystectomy. The reconstruction technique involved detubularization of a 40 cm ileal segment, formation of a spiral posterior wall plate for vertical traction resistance, and circumferential urethroileal anastomosis without a separate enterotomy. The ureters were anastomosed to a 10 cm afferent limb using the Wallace technique. Subsequently, clinical and perioperative outcomes were collected and compared between the hybrid and ICNB groups.

Results: The estimated blood loss or operative time did not significantly differ between the two groups. In both cohorts, no major perioperative complications occurred, and postoperative renal function remained stable. Both groups also achieved high continence rates. At 3-6 months postoperatively, the ICNB group obtained mean values of 174.9 mL for the neobladder volume, 24.2 mL/s for the maximum flow rate, and 10 mL for the post-void residual volume.

Conclusions: ICNB reconstruction using the Juntendo technique is safe and feasible as the hybrid approach while also yielding favorable early functional outcomes. Studies involving larger patient cohorts and longer follow-up periods is warranted for further validation of this technique.