Robot-assisted simple cystectomy for benign disease with medium-term follow-up: a case series

Background: Robot-assisted cystectomy (RAC) is well established in the management of muscle-invasive or high-grade non-muscle invasive bladder cancer, but its role in benign disease is less well described. This case series represents the largest published experience of RAC for radiation cystitis and the largest series using an intracorporeal urinary diversion technique in this context. Objectives: To evaluate perioperative outcomes and adverse events following RAC for benign indications, and to compare outcomes between patients with radiation cystitis and other benign conditions. Design: Single-centre, retrospective case series. Methods: Patients undergoing RAC for benign disease (2013–2024) were identified from a prospectively maintained database and electronic health records. Demographic, perioperative, and postoperative data were analysed using descriptive statistics. Comparative analyses were performed between patients undergoing cystectomy for radiation-related indications and those undergoing surgery for other benign indications using t tests, Fisher’s exact tests, and Mann–Whitney U tests in R. Results: Seventy patients (mean age 65 years; range 23–96) underwent RAC. Indications included radiation cystitis ( n = 34; 48.6%), other cystitis ( n = 14; 20%), premalignant changes ( n = 9; 12.9%), refractory overactive bladder ( n = 8; 11.4%), neurogenic bladder ( n = 4; 5.7%), and Fowler’s syndrome ( n = 1; 1.4%). Intracorporeal ileal conduit diversion was performed in 57 cases (81%). Mean operative time was 334 min (range 180–540). Mean blood loss was 326 ml (100–1250) in the radiation group and 300 ml (100–800) in other patients. Mean follow-up was 16 months (1–58). No significant decline in renal function was observed at 1 year in either group ( p = 0.8). Complications occurred in 46 patients (66%) within 90 days, with 34% graded Clavien-Dindo III or higher. Fifteen patients (21%) were readmitted within 30 days, and 8 (11%) required further intervention. Limitations include the retrospective design. Conclusion: RAC is safe and feasible for benign disease with no observed differences in outcomes between radiation cystitis and other indications in our cohort. Outcomes and complication rates observed are within the published ranges for malignancy-associated radical cystectomy. Trial registration: Not applicable.