Step-by-Step Approach to Extracorporeal Urinary Diversion in Robot-Assisted Cystectomy

Robot-assisted radical cystectomy (RARC) has established itself as a standard treatment for muscle invasive bladder cancer which to date has shown comparable perioperative and oncologic outcomes to the gold standard of open radical cystectomy. The primary morbidity associated with radical cystectomy remains the urinary diversion. Herein we will discuss important patient factors for diversion selection, provide a step-by-step approach to the different extracorporeal urinary diversions that may be performed in the setting of robot-assisted laparoscopic radical cystectomy (RARC) and report on specific risks, complication rates, and long-term data associated with each reconstruction technique. Specifically, we will discuss in detail the extracorporeal techniques of a Studer orthotopic neobladder, Indiana pouch continent cutaneous urinary diversion, and ileal conduit urinary diversion.