Robotic cystectomy as a last-resort treatment for refractory recurrent urinary tract infections

Objectives: Recurrent urinary tract infections (rUTI) are a common diagnosis that can often be treated with antibiotics and vaginal estrogen. Unfortunately there exists a subset of patients with recalcitrant infections, often requiring hospitalization for treatment, who are left with limited options to improve their poor quality of life. Here we report a case series of women with rUTI managed with robotic simple cystectomy and ileal conduit urinary diversion.

Methods: Following Institutional Review Board approval, all female patients who underwent robotic cystectomy for rUTI were identified from a prospectively-maintained internal database at a tertiary care academic center. Exclusion criteria included interstitial cystitis and neurogenic bladder diagnoses. Electronic medical records were reviewed by an independent researcher who was not involved in the patents’ care. Extracted data included: demographics, comorbidities, pre- and post-operative care, and operative reports. Patients were contacted by phone and administered the Quality of Life Questionnaire (QLQ-C30), which assesses physical, psychological, and social functioning on a scale of 0-100, with a higher score representing a higher level of functioning or impact. This questionnaire was selected as it is commonly used in the oncologic cystectomy literature and there is no corresponding measure specific to benign cases. Patient data was reported as median, range, and interquartile range (IQR).

Results: 24 female patients with recurrent urinary tract infections were managed with robotic simple cystectomy and ileal conduit urinary diversion from 2011-2021. Median age was 75 years (IQR 70-80). Demographics, health history, and rUTI history is summarized in Table 1. 6 patients completed a 0-10 quality of life (QoL) score preoperatively; median QoL score was reported as 5.5 (IQR 4.5-7), with higher score indicating worse QoL. Operative data and postoperative complications are summarized in Table 2. Two patients had intraoperative complications, consisting of vaginotomy repairs. Median postoperative followup duration was 14 months (IQR 5-28). Four patients had pyelonephritis/urosepsis >90 days postoperative, 3 in the setting of parastomal hernias and 1 with chronic hydronephrosis.

7 patients were able to complete the QLQ-C30 a median of 36 months (range 12-61) post-operative. Median global health status score was 50 (range 33-83), with higher score indicating improved QoL. Median physical functioning score was 40 (range 7-100), with higher score indicating improved function. Median emotional functioning score was 75 (range 58-100), with higher score indicating improved function. Median financial impact score was 0 (range 0-33), with higher score indicating greater burden.

Conclusions: Cystectomy is a last-resort management option for selected patients with rUTI. Patients should be counseled thoroughly regarding complications that may arise in the acute and long-term setting. Properly selected patients show quality of life benefits after undergoing robotic cystectomy with ileal conduit.