This video presents our early experience with robotic augmentation cystoplasty with completely intracorporeal reconstruction performed in a young female patient with neurogenic bladder and solitary kidney. 
Augmentation cystoplasty is a radical treatment for neurogenic bladder with reduced compliance and prevalently performed via an open approach. It has been reported to be safe and effective in preserving renal function and preventing anatomical deterioration, with high urinary continence rate, but it is also known for its invasiveness and morbidity (1) Robotic approach can provide faster functional recovery in such complex reconstructive surgery with greater precision and advantages of minimally invasive approach (2,3). 
This video shows our surgical technique of robotic augmentation cystoplasty with total intracorporeal reconstruction.

This is a case of a 28-year-old female with spina bifida and congenital absence of right kidney. She has a poorly compliant bladder with cystometric capacity of 150 ml, detrusor overactivity and Grade 3-4 vesicoureteral reflux.
The patient has tried anticholinergic medical therapy, intradetrusor botulinium A injections with intermittent self-catheterisation and long-term indwelling catheterisation.  In view of preserving her renal function from further deterioration and improving her quality-of-life in this young lady, augmentation cystoplasty was performed.   The procedure started with endoscopic placement of a 6F open ended ureteric catheter to the left ureter and insertion of a 24 Fr 2-way hydrogel indwelling urethral catheter in lithotomy position. Patient was then placed in a 25 degrees Trendelenburg position. Trocar insertions, as for robotic-assisted radical cystectomy on the da Vinci XI robotic system, with modification for two 5 mm assistant ports at the hypochondrium bilaterally. The bladder was mobilised and longitudinal cystotomy performed revealing the preplaced ureteric catheter.  A 40 cm segment of small bowel, 20cm from ileocecal junction, was used to create the enterocystoplasty.Indocyanine Green (ICG) test was performed to confirm viability of remnant bowel and enterocystoplasty segment. End-to-end ileal anastomosis performed with Sureform stapler.  Enterocystoplasty created in a W-loop ileal configuration with each ileal limb measuring 10cm long. The Ileal W loop was sequentially detubularised on the antimesenteric border. An ileal enterocystoplasty was created by interlimb anastomosis, followed by ileal-bladder anastomosis. Leak test was performed and drain inserted.

Total operative time was 550 minutes, with blood loss of less than 50 ml. Complete return of bowel function on post-operative day 3, drain removed on post-op day 7, and patient was discharged well on post-op day 10. 
Postoperative cystogram at 3 weeks showed no contrast extravasation, increased bladder capacity with Grade 1 left vesicoureteral reflux. Her renal function improved post-operatively.

Robotic-assisted laparoscopic augmentation cystoplasty is a minimally invasive alternative to an open approach.  It requires careful pre-operative preparation and coordination. However, total intracorporeal cystoplasty is meticulous and time consuming with its challenges of limited operative space with much bowel handling. This is an encouraging experience as the inaugural case of robotic augmentation cystoplasty with complete intracorporeal reconstruction in our country.

Kang IS, Lee JW, Seo IY. Robot-assisted laparoscopic augmentation ileocystoplasty: a case report. Int Neurourol J. 2010 Apr;14(1):61-4. doi: 10.5213/inj.2010.14.1.61. Epub 2010 Apr 30. PMID: 21120178; PMCID: PMC2989477.
David Carracedo Calvo, Miguel Toledo Jiménez, Pietro Moscatiello, Tamara Jerez Izquierdo, Nathalie Pereira Rodríguez, Miguel Sánchez Encinas, Robotic augmentation enterocystoplasty as a treatment for overactive bladder syndrome: Case report, International Journal of Surgery Case Reports,Volume 129, 2025, 111173, ISSN 2210-2612.
Nuno Grilo, Emmanuel Chartier-Kastler, Pietro Grande, François Crettenand, Jérôme Parra, Véronique Phé, Robot-assisted Supratrigonal Cystectomy and Augmentation Cystoplasty with Totally Intracorporeal Reconstruction in Neurourological Patients: Technique Description and Preliminary Results, European Urology,Volume 79, Issue 6, 2021,Pages 858-865.

Continence 19S (2026) 102601
DOI: 10.1016/j.cont.2026.102601