Robot-assisted tubeless radical cystectomy: Is the absence of ureteral drainage a mistake?

OBJECTIVE

Radical cystectomy is the gold standard technique for muscle-invasive bladder cancer and resistant non muscle-invasive bladder cancer. This surgery presents a high rate of complications despite the advance of robotic surgery. The aim of this study is to compare the complications according to the presence of ureteral stents or not.

METHODS

Two hundred consecutive patients who underwent robotic radical cystectomy for bladder cancer at our center between 2012 and 2022 were included in this retrospective study. Cessation of upper tract drainage was introduced prospectively in February 2021, without any selection bias. Patients were divided into 2 groups: ureteral stents (US) or no ureteral stents (NUS). All complications were analyzed during 3 postoperative months. Urinary diversion-specific complications were analyzed during 12 postoperative months.

RESULTS

Over the 200 included patients, 58 did not have any ureteral stents (29%). The overall postoperative complication rate was nearly identical between the NUS group at 48% and the US group at 53% (P=0.56). The rate of severe complications≥Clavien3a seemed lower in the NUS group at 15% versus 24% in the US group (Chi2: 1.73, P=0.19), as were the rates of infectious complications: NUS 29% versus US 38% (Chi2: 1.20, P=0.27). These results were the same in subgroup analyses. Complications on the urinary diversion at 12 months were 12% for the NUS group and 20% for the US group (Chi2: 1.67, P=0.196).

CONCLUSION

Going against all dogmas, the absence of upper urinary tract drainage for cystectomy does not increase the risk of early and late complications, and even seems to limit infectious and late complications such as stenosis.