Optimal use and outcomes of orthotopic neobladder reconstruction in men and women.

Objective: Urethra-sparing has become a standard in patients undergoing radical cystectomy for bladder cancer showing excellent oncologic outcome in large retrospective studies. However, data on functional outcome and quality of life are still conflicting. This review aims to summarize recent data on oncologic and functional outcome of patients undergoing orthotopic urinary diversion.

Results: Orthotopic urinary diversion can be performed safely in patients with negative urethral resection margins in frozen section analysis. Minimally invasive cystectomy shows short-term and long-term oncologic outcomes comparable with open cystectomy. In the meantime, more than 150 cases of total intracorporeal diversion have been published demonstrating promising perioperative results. However, only few data exist on functional outcome of this procedure. For open neobladder substitution, there is still a broad variability in continence rates, voiding function and health-related quality of life between different studies. However, the number of studies using validated tools for assessment of functional outcome is constantly increasing showing promising long-term outcomes of the procedure.

Conclusions: Both in men and in women, orthotopic neobladder should be considered as standard-of-care with excellent long-term oncologic and functional outcome. Due to lack of long-term functional and oncologic data, total intracorporeal diversion should be limited to selected patients and centers with broad expertise in robotic surgery.