Combined Robot-Assisted Radical Cystectomy and Robot-Assisted Nephroureterectomy for Synchronous High-Risk Upper Urinary Tract and Bladder Cancer. A Single Center Retrospective Study and Review of the Literature

Background/ Objectives Simultaneous robotic-assisted radical cystectomy (RARC) and nephroureterectomy (RARNU), offers a minimally invasive alternative to open approach, for patients with synchronous bladder and upper urinary tract cancers, as well as in selected benign conditions. This study presents our single-center experience and includes a review of the relevant literature. Methods All patients undergoing combined RARC and RARNU between 2016 and 2023 were retrospectively identified. Clinical and demographic data—including preoperative pathology, operative and re-docking time, estimated blood loss, complications (Clavien-Dindo system), surgical margins, recurrence, morbidity, and follow-up—were collected. A rapid literature review was also conducted. Results From 2016 to 2023, 10 patients (mean age 67.4 years, range 56–77) underwent combined RARC and RARNU for upper/lower tract urothelial malignancy. Mean re-docking time was 68.2 min (range 51–100), operative time 524.5 min (range 380–690), and blood loss 427 cc (range 75–1170). A Pfannenstiel incision was used for en bloc specimen extraction, with no complications or incisional hernias. One case was converted to open surgery, and two required extracorporeal diversion. Postoperatively, five Grade 2, one Grade 3, and one Grade 5 complications were reported. All surgical margins were negative. Mean hospital stay was 11.5 days (range 5–29). At a mean follow-up of 21.7 months, one patient became dialysis-dependent and one experienced recurrence requiring further surgery. Literature review included 74 patients with comparable outcomes. Conclusions Combined RARC and RARNU is a feasible, minimally invasive option for selected patients. Although technically demanding, it offers acceptable safety and should be performed in high-volume, specialized centers.