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RESEARCH ARTICLE

Role of a spray-type anti-adhesion barrier (AdSpray®) in post-operative outcomes following robot-assisted radical cystectomy for bladder cancer

Yuki Oda1† ,  Makito Miyake1† ,  Tatsuki Miyamoto1 ,  Takuto Shimizu1 ,  Mitsuru Tomizawa1 ,  Shunta Hori1 ,  Yosuke Morizawa1 ,  Daisuke Gotoh1 ,  Yasushi Nakai1 ,  Nobumichi Tanaka1,2 ,  Kiyohide Fujimoto1*
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1 Department of Urology, School of Medicine, Nara Medical University, Kashihara, Nara 634-8521, Japan
2 Department of Prostate Brachytherapy, School of Medicine, Nara Medical University, Kashihara, Nara 634-8521, Japan
Bladder, e21200080 https://doi.org/10.14440/bladder.0281
Submitted: 29 August 2025 | Revised: 1 December 2025 | Accepted: 9 December 2025 | Published: 9 January 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Despite advances in robot-assisted radical cystectomy (RARC) for bladder cancer and enhanced recovery protocols, post-operative gastrointestinal complications—particularly ileus and bowel obstruction—remain a significant clinical problem. Objective: We investigated whether intraoperative AdSpray® (TERUMO) during RARC is associated with fewer post-operative complications and improved recovery, with a focus on gastrointestinal events. Methods: We retrospectively reviewed consecutive patients who underwent RARC with urinary diversion at a single tertiary hospital between June 2019 and March 2025. The primary endpoint was any post-operative complication within 90 days. Prespecified gastrointestinal complications included paralytic ileus, intestinal obstruction, anastomotic leak, and anastomotic stricture. Additional outcomes were time to first liquid intake, time to resumption of a normal diet, and time to discharge. Intestinal obstruction was defined as a computed tomography-demonstrated transition point with compatible clinical findings, and paralytic ileus as radiographic ileus without obstruction. One-to-one propensity score matching (PSM) was used to balance baseline characteristics between the AdSpray and non-AdSpray groups. Post-matching logistic regression was used to estimate associations with binary outcomes, and time-to-event outcomes were analyzed using Kaplan–Meier methods. Results: Among 71 patients, 17 (24%) received AdSpray, and 54 (76%) did not; PSM yielded two comparable cohorts (n = 17 each). AdSpray use was significantly associated with a lower 90-day incidence of intestinal obstruction in the matched cohorts (odds ratio = 0.15, 95% confidence interval = 0.02–0.88, p = 0.032). Times to resumption of oral intake and discharge were similar between groups (before PSM, log-rank p = 0.64; after PSM, log-rank p = 0.42). Conclusion: These retrospective findings are hypothesis-generating and suggest that intraoperative AdSpray use during RARC may be associated with a reduced 90-day incidence of intestinal obstruction; however, they should not be interpreted as definitive evidence of a causal relationship.

Keywords
Bladder cancer
Robot-assisted radical cystectomy
AdSpray
Intestinal obstruction
Post-operative complications
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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