Ureteroenteric Anastomotic Strictures Following Robotic Radical Cystectomy: Extracorporeal Versus Intracorporeal Approaches in the Indocyanine Green Era

摘要

Objective:The aim of this study was to compare the early period iatrogenic benign ureteroenteric anastomotic stricture formation between robotic radical cystectomy with extracorporeal urinary diversion, robotic radical cystectomy with intracorporeal urinary diversion [without using indocyanine green (ICG)] and robotic radical cystectomy with intracorporeal urinary diversion (with using ICG).Materials and Methods:A total of 30 patients (59 renal units) who underwent robotic radical cystectomy and urinary diversion intracorporeally or extracorporeally for muscle-invasive bladder cancer between 2014 and 2021 were included in this study. We retrospectively reviewed the demographic data and perioperative results. The primary endpoint of our study was the ureteroenteric stricture formation rate at the 6th week after the single-J ureteral catheter removal.Results:From our study cohort; 13 of these patients (26 renal units) urinary diversions were performed using extracorporeal approach (group 1), 10 of these patients (20 renal units) urinary diversions were performed by intracorporeal approach without using ICG (group 2) and 7 of these patients (13 renal units) urinary diversions were performed by intracorporeal approach with using ICG (group 3). The overall incidence of early period ureteroenteric stricture formation (post-operative 6th week after the single J catheter removal) was 8.5% (5 renal units); 11.5% (3 renal units) after extracorporeal approach (group 1); 10% (2 renal units) after intracorporeal approach without using ICG (group 2). None of the patients with intracorporeal approach using ICG (group 3) had a demonstrable ureteroenteric stricture at post-operative 6th week after the single J catheter removal.Conclusion:Robotic intracorporeal urinary diversion with using ICG is a promising approach in terms of preventing benign ureteroenteric strictures.