Robotic surgery for paediatric neurogenic lower urinary tract dysfunction: a systematic review

Objective

To evaluate in a systematic review the outcomes, benefits, and limitations of robot-assisted surgeries for paediatric neurogenic lower urinary tract dysfunction (LUTD), as robot-assisted techniques have emerged as a potential alternative, offering enhanced precision, dexterity, and visualisation.

Methods

This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier CRD42023464849) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies of paediatric patients (aged <18 years) with neurogenic LUTD undergoing robot-assisted continence surgery, assessing safety and efficacy. Literature searches in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), and Scopus were conducted until 12 July 2024. Data extraction included surgical procedures, complications, operative times, lengths of stay, and bladder function outcomes.

Results

A total of 42 studies (20 case reports, 10 case series, six cohort studies, six comparative cohort studies) were included. Robotic procedures for continent catherisable channel construction, augmentation cystoplasty, and bladder neck reconstruction showed comparable peri- and postoperative outcomes. Meta-analysis of five studies comparing robotic vs open appendicovesicostomy indicated a significant reduction in length of stay for robotic groups, while operative time, complications, and re-intervention rates were not significantly different. Conversions to open surgery were rare, indicated by adhesions or small appendices during channel constructions.

Conclusions

Robot-assisted surgeries for paediatric neurogenic LUTD demonstrate potential benefits, including reduced hospital stays and comparable complication rates to open surgery in certain contexts. However, the available evidence is limited by heterogeneity in study designs, small sample sizes, and single-centre experiences, which constrain generalisability. Standardised reporting of complications and outcomes, alongside multicentre studies, is essential to clarify the long-term efficacy and broader applicability of these techniques.