Intra-corporal vs Extra-corporal Urinary Diversion After Robot Assisted Radical Cystectomy

This is a randomized clinical trial comparing ICD to ECD following robotic-assisted radical
cystectomy (RARC). All patients will undergo the standard of care for RARC followed by either
extracorporal urinary diversion (ECD) or intracorporal urinary diversion (ICD). RARC will be
performed as per center-specific techniques, which on the whole are comparable. The surgical
approach for ileal conduit formation will be standardized with the requirement for ureteral
stents in all patients. The post-operative care of all patients will involve use of an
enhanced-recovery after surgery (ERAS) protocol. Certain components of this protocol will be
standardized.

Patients will be followed-up as per the usual standard of care for RARC followed by urinary
diversion. History and physical examination are recommended at 30 days, 3, 6, 12, 24 months
postoperatively, and as per the clinician's discretion afterwards. During each follow up
functional assessment for urinary and sexual quality of life will be performed as per the
study calendar.

Inclusion Criteria:

- Biopsy-proven urothelial cancer being considered for RARC.

- Clinical stage T1-T4, N0-1, M0 or refractory carcinoma in situ.

- Subject must be already scheduled to have a RARC at the discretion of the surgeon and
with the patient's agreement.

Exclusion Criteria:

- Inability to give informed consent

- Prior major abdominal and pelvic open surgical procedures that would preclude a safe
robotic approach, as determined by the treating surgeon.

- At the discretion of the treating surgeon, any pre-existing condition such as severe
chronic obstructive pulmonary disease that precludes a safe initiation or maintenance
of pneumoperitoneum over a prolonged period of time and during surgery.

- Age <18 or >99 years.