Abstract
OBJECTIVES: A range of techniques have been described for robotic-assisted intracorporeal neobladder construction. The pyramid neobladder has now been performed for over 10 years. We now describe the long-term outcomes, including the impact of function preservation through nerve and prostate capsule sparing in the male population. SUBJECTS/PATIENTS AND METHODS: All patients who underwent pyramid neobladder construction between January 2015 and December 2023 at the University College London Hospital (UK) were reviewed. Patients were selected for function preservation based on baseline sexual function/wishes, PSA ± multiparametric prostate MRI. Selected oncological, functional and patient reported outcomes were assessed. RESULTS: A total of 71 patients were included; 87% (61/71) were men. About 65% (40/61) underwent either nerve- or prostate capsule-sparing surgery. Median follow-up was 57.8 months (IQR 48.3). In male patients, there was no difference between the 12- and 24-month cancer specific and overall survival rates between the function sparing groups. There were no positive prostate cancer margins. Daytime continence was 75% (39/52) and 67% (6/9), and nighttime was 17% (9/52) and 11% (1/9), in men and women, respectively. There was no significant difference between the male function sparing groups (p < 0.342). About 94% of men (29/31) were sexually active before surgery, falling to 55% (17/31) after, with 76% (13/17) using treatment for erectile dysfunction. The median change in SHIM score was 4.5 (SD 5.3) in prostate capsule-sparing, 6 (SD 7.7) in nerve-sparing and 17 (SD 2.8) in standard groups.About 45% (30/66) of patients had a significant reduction in eGFR (>10 mL/min/1.73m(2)). Uretero-ileal strictures were confirmed in 4.2% (3/71). About 28% (19/67) of patients reported recurrent UTIs and 7% (5/71) reported neobladder rupture. CONCLUSION: Sexual function had the largest impact on quality of life and may be improved with function-sparing techniques. The burden of additional complications including neobladder rupture and urinary tract infections was also highlighted.