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Total intracorporeal versus open bladder cuffing in Robotic Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

  • Sang Hun Song
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea

    Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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  • Jin Hyuck Kim
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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  • Sangchul Lee
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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  • Sung Kyu Hong
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea

    Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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  • Seok-Soo Byun
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea

    Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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  • Jong Jin Oh
    Correspondence
    Corresponding author: Jong Jin Oh, M.D., Ph.D., Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, Korea 463-707, Tel: 82-31-787-7351, Fax: 82-31-787-4057
    Affiliations
    Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea

    Department of Urology, Seoul National University College of Medicine, Seoul, Korea
    Search for articles by this author
Published:January 13, 2023DOI:https://doi.org/10.1016/j.urology.2022.09.048

      Abstract

      Objective

      To evaluate a single institution experience of total intracorporeal bladder cuffing and distal ureterectomy (DUBC) in robotic radical nephrouretectomy (RNU) for upper tract urothelial carcinoma (UTUC).

      Materials and Methods

      168 patients treated for UTUC with robotic RNU at our institution from May 2009 to October 2019 were retrospectively analyzed. 92 patients underwent total intracorporeal DUBC after robotic dock repositioning, whereas 76 patients underwent open methods via Gibson incision. Perioperative outcomes including operation time, estimated blood loss (EBL), transfusion rates, use of painkillers, Visual analogue scale (VAS) pain scores, and complication rates were compared, as well as pathological and oncological outcomes. Uni- and multi-variate Cox regression models were performed for survival analysis.

      Results

      There were no significant differences in baseline patient characteristics between the two groups. Patients who underwent intracorporeal bladder cuffing had less EBL (169.8±150.4 vs 214.6±157.0, p=0.091) and decreased pain at 1 week (VAS score 1.18±1.1 vs. 2.2±1.1, p=0.017). Pathological outcomes were not significantly different, and oncological outcomes including local and intravesical recurrence, cancer-specific and overall mortality were comparable to patients who received extracorporeal bladder cuffing. Intracorporeal bladder cuffing was not associated with increased risk of progression on univariate analysis (HR 0.600, 95% CI 0.314-1.147; p=0.122).

      Conclusion

      Based on our experience, intracorporeal DUBC can be a safe and oncologically non-inferior alternative method to RNU, with benefits of decreased EBL and postoperative pain. Future prospective trials are necessary to further validate our results.

      Keywords

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