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Introduction: Total intra-corporeal robot-assisted radical cystectomy (RARC) with total intracorporeal neobladder formation is relatively new in the treatment of bladder cancer. We present our experience and believe it is the first Canadian reported series with this technique., Methods: This is a case series of 4 patients, who underwent total RARC, pelvic lymphadenectomy and creation of an intra-corporeal ileal neobladder. Surgical technique is described and perioperative variables, pathologic data, and complication rates are reported., Results: The mean patient age was 61.8 and the mean body mass index was 27.01 kg/m(2). The mean operative time, estimated blood loss, time to full diet and length of stay were 522.8 minutes (standard deviation [SD] 74.5), 237.5 mL (SD 47.9), 9 days (range: 3-24) and 12.8 days (range: 6-31), respectively. All patients completed postoperative functional evaluation showing a mean neobladder capacity of 575 cc (range: 500-720). Surgical margins and pathological nodal status were negative in all patients with no evidence of disease recurrence or progression on follow-up. Three of the 4 patients suffered a complication within 90 days, with one occurring later in the first year. All early complications were Clavien grade I-II (grade I [n = 1]; grade II [n = 2]) and the later complication was grade IIIa. The mean follow-up was 632 days (range: 562-730). The limitation of our study is its small sample size with highly selected patients to compensate for the learning experience. The follow-up is short; however, the outcomes are comparable to early experiences reported at other institutions., Conclusions: In our initial experience, RARC with total intracorporeal neobladder formation is safe. We expect that with experience the expense of robotic surgery can be compensated with early ambulation and shorter stay.

Introduction: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty., Methods: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression., Results: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence., Conclusion: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.