Intracorporeal Studer Pouch Formation with Balbay's Technique Following Robotic Radical Cystectomy for Bladder Cancer: Experience with 22 Cases with Oncologic and Functional Outcomes

Aim: Robot-assisted radical cystectomy (RARC) with intracorporeal Studer pouch formation (ICSPF) is increasingly being performed. Balbay's technique of ICSPF replicates the open approach with the additional advantages of inserting internal Double-J stents. Materials and Methods: Between June 2011 and April 2019, 22 patients with muscle-invasive bladder cancer were included who underwent RARC and ICSPF with Balbay's technique. Mean follow-up was 35.7 months. Operative, postoperative, and pathological measures, complications, and oncologic and functional outcomes were evaluated. Results: Mean operation time, estimated blood loss, mean lymph node yield, and mean duration of hospital stay were 9.2 hours, 361.4 mL, 38.6, and 10.5 days, respectively. Surgical margins were positive in 3 (9.1%) patients. Postoperative pT stages included pT0 (n = 4), pTis (n = 4), pT1 (n = 2), pT2 (n = 1), pT3a (n = 3), pT3b (n = 5), and pT4a (n = 3). Daytime continence outcomes were (patients with ≥1-year follow-up, n = 17) as follows: 10 (58.8%) fully continent, 4 (23.5%) mild, and 3 (17.7%) moderate incontinence. Two-year cancer-specific survival, overall survival, and recurrence-free survival were 68.6%, 66.0%, and 69.7%, respectively. The retrospective nature of the study was the main limitation. Complications (modified Clavien-Dindo classification, n = 32) included 23 minor and 2 major during the perioperative (0-30 days) period and 3 minor and 4 major during the postoperative (31-90 days) period. Ileus developed in 3 patients (9.3%). Readmission rates were 3 (13.6%) and 8 (36.4%) in perioperative and postoperative periods, respectively. Conclusions: RARC and ICSPF by Balbay's technique have acceptable morbidity, excellent surgical and pathological outcomes, and satisfactory oncologic and functional results with additional advantages of exclusion of external stents, exact replication of the open approach, and fewer gastrointestinal complications.