In recent years, several intracorporeal orthotopic neobladders (iONBs) reconstructions after robotic radical cystectomy (RARC) using intestinal segments with detubularised ileum have been described. However, robust functional data comparing different robotic iONBs techniques are currently missing. The aim of this series was to compare the early urodynamic and functional outcomes of Padua (PIN) and Florin iONBs performed at two high-volume centres.

Between June 2017 and December 2020 two prospective, board-approved, radical cystectomy datasets were matched and queried for “urodynamic evaluation”, “robotic Florin neobladder” (Group A; n=23), “robotic Padua Ileal neobladder” (Group B; n=24). Complete urodynamic profile including uroflowmetry, cystometry, compliance, presence of residual peristaltic activity, abdominal leak point pressure (ALPP) as functional outcomes assessed by daytime and night-time continence (defined as the use of 0-1 pad) and stress incontinence rates were compared between groups. Descriptive analyses were used. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Differences between continuous variables were assessed with t test, while Pearson’s χ2 test was used for categorical data. For all analyses, a two-sided p<0.05 was considered significant.

Overall, at a median follow-up of 8 months (IQR 7-15) 47 patients achieved a complete urodynamic evaluation (Table 1). In the group A patients were older (67 vs 61; p=0.03) with a shorter follow-up (7 vs 13; p=0.01). Compared to PIN, Florin pouch showed a lower cystometric capacity (260  vs 302 cc) and compliance (15.7 vs 10 cmH20) (each p<0.05). The rate of neobladder residual peristaltic activity, end-filling pressure, maximal flow rate, and postvoid residual urine volume were comparable between groups (each p>0.05). The ALPP was significantly increased in the PIN cohort (90 vs 60 cmH20; p=0.036) while the stress urinary incontinence rate was comparable between groups (p=0.608). In the Florin series the daytime and night-time continence rates were 82.6% and 50% while in the PIN series were 75% and 50%, respectively (each p>0.5; Table 2). PIN showed a later onset of night-time urinary continence (6 vs 3 months) and an increased rate of clean intermittent catheterization (16.7 vs 4.3%) (each p<0.03)

Basing on our data, Florin pouch appeared to reach a lower cystometric capacity and compliance than PIN; on the other hand, PIN showed a later onset of night-time continence and an increased rate of CIC. However, no significant differences were found for other urodynamic parameters such as neobladder residual peristaltic activity, end-filling pressure, maximal flow rate and PVR. In particular, continence rates were comparable, and so were the stress urinary incontinence rates, showing no superiority of one neobladder on the other.

Florin pouch and PIN achieved excellent continence rates at an early follow-up. Technical nuances of ileal detubularisation and folding may explain the disparity between Florin and PIN in terms of cystometric capacity and compliance. The  urodynamic and functional results obtained support both iONBs as a safe option comparable to their open counterpart after RARC

Benamran D, Phé V, Drouin SJ et al;  Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review. J Robot Surg. 2020 Dec;14(6):813-820.
Simone G, Papalia R, Misuraca L et al Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. Eur Urol. 2018 Jun;73(6):934-940
Minervini A, Vanacore D, Vittori G, et al; Florence robotic intracorporeal neobladder (FloRIN): a new reconfiguration strategy developed following the IDEAL guidelines. BJU Int. 2018 Feb;121(2):313-317