"Far beyond the shape": an early head-to-head comparative urodynamic analysis of three contemporary totally intracorporeal robotic orthotopic neobladder techniques.

The expanding use of totally intracorporeal orthotopic neobladder (ICONB) reconstruction after robot-assisted radical cystectomy has fostered multiple configuration variants, yet robust comparative functional data remain limited. This early head-to-head study aimed to assess whether three contemporary ICONB configurations-Padua Ileal Neobladder, Florence Robotic Intracorporeal Neobladder (FloRIN), and a Y-shaped neobladder-deliver comparable urodynamic and continence outcomes despite anatomical nuances. Three prospectively maintained institutional cystectomy databases were merged. Patients who underwent robot-assisted radical cystectomy with ICONB and completed a standardized early multichannel urodynamic assessment were included. Cystometric capacity, compliance, residual peristaltic activity, leak point pressures, and functional continence (daytime and night-time) were compared across configurations. Functional recovery probabilities were estimated using Kaplan-Meier curves and compared with the log-rank test. Non-parametric tests were applied for other comparisons. A total of 142 patients were analyzed (Padua n = 45, FloRIN n = 49, Y-shaped n = 48). Median cystometric capacity was highest in the Padua configuration (346 mL [IQR 272-400]) versus FloRIN (269 mL [242-305]) and Y-shaped (245 mL [200-290]; p < 0.001). Compliance was most favorable in FloRIN (22 mL/cmH₂O [15-27]) compared to Padua (16 [11-41]) and Y-shaped (12 [10-19]; p = 0.029). Residual peristaltic activity and leak point pressures showed minor differences without functional impact. Daytime continence rates were similar (Padua 80%, FloRIN 83%, Y-shaped 79%; p = 0.40); night-time continence followed the same pattern (65%, 70%, 66%; p = 0.30). Kaplan-Meier curves demonstrated overlapping functional recovery trajectories (daytime p = 0.744; night-time p = 0.122). This early head-to-head comparison suggests that when core reconstructive principles are met, contemporary totally intracorporeal neobladder configurations yield distinct urodynamic profiles but comparable functional outcomes. Future efforts should define clear qualitative and temporal standards for urodynamic monitoring to support consistent functional evaluation as robotic cystectomy adoption expands.