Tubeless Ureteroenteric Anastomosis in Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion does not increase the risk of anastomotic stenosis or postoperative complications

Abstract Objective To demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. Methods We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis and in the second cohort stenting was omitted. Results Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regards to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Conclusions Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion doesn’t appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.