Introduction: To investigate the outcome of robotic augmentation cystoplasty as the treatment of refractory cystitis due to ketamine abuse, and to compare the results of the anterior versus posterior surgical approaches. Methods: This is a prospective series of patients with refractory lower urinary symptoms and a small contracted bladder due to ketamine-associated cystitis, who were indicated for augmentation cystoplasty. Robotic augmentation cystoplasty was performed with either the conventional anterior clamp cystoplasty approach, or the posterior U-flap M-configuration cystoplasty technique. Peri-operative data were collected and one-year outcome assessment was performed including functional bladder capacity (FBC) with urodynamic study, renal function and analgesic consumption. Results: Between July 2011 and April 2021, 24 patients underwent robotic augmentation cystoplasty. Mean age was 32.0 ± 5.8 years. Additional procedures included 4 ureteric-reimplantations and 1 ileal interposition. Significant FBC improvement was observed 1 year after the operation (pre-operative 56.7 ± 36.2 ml, post-operative 328.5 ± 163.8, p<0.0001). FBC of anterior approach and posterior approach at 1 year was 312.5 ± 163.6 ml and 362.5 ± 161.4 ml respectively (p=0.276). Mean operative time was 272.0 ± 103.3 minutes. Analgesic requirement was decreased after the operation (pre-operative 19 patients, post-operative 4 patients; p<0.0001). Post-operative complications included 8 Clavien-Dindo grade 1 incidences and 1 Clavien-Dindo grade 3B incidence (small bowel obstruction requiring laparotomy and small bowel resection). Conclusions: Robotic augmentation ileo-cystoplasty can provide significant symptom relief for patients with a small contracted bladder. Both anterior and posterior approaches of robotic augmentation ileo-cystoplasty did not show any difference in the improvement in functional bladder capacity after the operation. SOURCE OF Funding: Nil
