How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN)

Di Maida, Fabrizio; Lambertini, Luca; Grosso, Antonio Andrea; Salamone, Vincenzo; Paganelli, Daniele; Di Stefano, Laura; Conte, Francesca; Lipparini, Filippo; Salvi, Matteo; Oriti, Rino; Mari, Andrea; Minervini, Andrea

doi:10.3390/jcm14238397

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How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN)

by

Fabrizio Di Maida

^1,2,*,†

,

Luca Lambertini

^1,2,†,

Antonio Andrea Grosso

^1,2

,

Vincenzo Salamone

^1,2

,

Daniele Paganelli

^1,2,

Laura Di Stefano

^1,2,

Francesca Conte

^1,2,

Filippo Lipparini

^1,2,

Matteo Salvi

^1,2,

Rino Oriti

^1,2,

Andrea Mari

^1,2

and

Andrea Minervini

^1,2

¹

Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy

²

Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, 50134 Florence, Italy

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2025, 14(23), 8397; https://doi.org/10.3390/jcm14238397

Submission received: 3 October 2025 / Revised: 16 November 2025 / Accepted: 23 November 2025 / Published: 26 November 2025

(This article belongs to the Special Issue Robot-Assisted Surgery: Current Trends and Future Directions)

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Abstract

Background: Orthotopic neobladder in women presents functional challenges, notably hyper-continence requiring intermittent self-catheterization. Here, we describe a three-layer urethro-ileal anastomosis incorporating a peritoneal flap and evaluate its impact on functional outcomes at the time of robot-assisted radical cystectomy (RARC) and Florence Robotic Intracorporeal Neobladder (FloRIN) reconfiguration. Methods: Clinical data from consecutive patients treated with non-sexual-sparing RARC and FloRIN were prospectively collected between March 2016 and January 2024. Hyper-continence was defined as intermittent self-catheterization or postvoid residual > 200 cc at last follow-up. A three-layer anastomosis was performed incorporating a peritoneal flap and utilizing a three-step barbed suture technique for posterior reconstruction: (1) the peritoneum of the rectouterine pouch was sutured to the paraurethral ligaments, (2) the external ileal layer was approximated to the paraurethral ligaments, and (3) the ileal mucosa was anastomosed to the urethra. Urodynamic evaluation was performed 6 months postoperatively. Results: Overall, 32 patients entered the study. Median age was 72 (IQR 67–75) years, and median BMI was 24 (IQR 22–27) kg/m². Preoperative incontinence was reported in 10% of cases, while no hyper-continence was recorded preoperatively. Median console time was 334 (IQR 305–363) minutes. Early major complications (<30 days) occurred in three (9.4%) patients, while delayed major complications (>30 days) were observed in four (12.5%) cases. After a median follow-up of 36 (IQR 30–42) months, hyper-continence was observed in 7.2% of patients with a median self-catheterization number of 3 (IQR 2–5) per day. Multivariable analysis confirmed BMI > 25 kg/m² (OR: 1.24, p = 0.03) and age > 70 years (OR: 1.18, p = 0.04) as independent predictors of hyper-continence after FloRIN. Conclusions: Robot-assisted three-layer posterior reconstruction during FloRIN configuration in female patients demonstrated low rates of hyper-continence and no cases of permanent catheterization in long-term follow-up.

Keywords: continence; FloRIN; neobladder; posterior reconstruction; robotic

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MDPI and ACS Style

Di Maida, F.; Lambertini, L.; Grosso, A.A.; Salamone, V.; Paganelli, D.; Di Stefano, L.; Conte, F.; Lipparini, F.; Salvi, M.; Oriti, R.; et al. How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN). J. Clin. Med. 2025, 14, 8397. https://doi.org/10.3390/jcm14238397

AMA Style

Di Maida F, Lambertini L, Grosso AA, Salamone V, Paganelli D, Di Stefano L, Conte F, Lipparini F, Salvi M, Oriti R, et al. How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN). Journal of Clinical Medicine. 2025; 14(23):8397. https://doi.org/10.3390/jcm14238397

Chicago/Turabian Style

Di Maida, Fabrizio, Luca Lambertini, Antonio Andrea Grosso, Vincenzo Salamone, Daniele Paganelli, Laura Di Stefano, Francesca Conte, Filippo Lipparini, Matteo Salvi, Rino Oriti, and et al. 2025. "How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN)" Journal of Clinical Medicine 14, no. 23: 8397. https://doi.org/10.3390/jcm14238397

APA Style

Di Maida, F., Lambertini, L., Grosso, A. A., Salamone, V., Paganelli, D., Di Stefano, L., Conte, F., Lipparini, F., Salvi, M., Oriti, R., Mari, A., & Minervini, A. (2025). How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN). Journal of Clinical Medicine, 14(23), 8397. https://doi.org/10.3390/jcm14238397

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How to Minimize Hyper-Continence After Intracorporeal Robotic Neobladder Configuration in Women? The Three-Layer Posterior Reconstruction During Florence Robotic IntraCorporeal Neobladder (FloRIN)

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