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

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.