Robotic major reconstruction in pediatric urology: A scoping review of catheterizable channels and bladder augmentation.

BACKGROUND

Robotic assistance has expanded the scope of minimally invasive major reconstruction in pediatric urology, but adoption varies and comparative advantages over open surgery remain uncertain.

OBJECTIVES

ELIGIBILITY CRITERIA: English-language clinical studies reporting primary data on patients <18 years old undergoing the targeted robotic procedures for neurogenic bladder or severe voiding dysfunction. Oncologic indications, editorials, nonclinical studies, and abstracts without full text were excluded.

SOURCES OF EVIDENCE: MEDLINE (Ovid), Embase (Embase.com), Cochrane Library (Wiley: CDSR and CENTRAL), and Web of Science Core Collection (Clarivate).

CHARTING

METHODS

A standardized extraction form (with calibration) captured bibliographic details, study design, patient and procedural characteristics, and outcomes (operative time, estimated blood loss, length of stay, pain, complications, continence, reoperation, follow-up). Data were summarized descriptively in tables/figures; no meta-analysis was performed due to heterogeneity of reported data.

RESULTS

Of 218 records screened, 66 studies were included from 2004 to 2024. Many were case reports/series. Feasibility reports for catheterizable channels (±augmentation/BNR) showed low conversion-to-open (7%), complication rate of 16.7% (most commonly stomal stenosis, wound infection, UTI), mean length of stay 5.7 days, and reported success/continence of ∼99%. Six retrospective comparisons (136 robotic vs 121 open cases) found higher (∼40%) but similar complication, reoperation, and continence rates between the robotic and open approach. Descriptive trends favoring robotics were lower postoperative morphine equivalents, less estimated blood loss (EBL) and shorter hospital stays. However all studies reported longer robotic operative times.

CONCLUSIONS

Current literature suggests that robotic major reconstruction in pediatric urology is feasible and safe in experienced hands, with acceptable short and mid-term outcomes in experienced centers. However, long-term functional and overall outcomes remain limited compared to open cohorts. Available comparative studies report broadly similar outcomes, though these findings should be interpreted cautiously given heterogeneity and limited follow up. Adoption of robotic surgery for lower urinary tract reconstruction in children remains constrained by pediatric anatomy, costs, learning curves, and case volume. Standardized definitions of continence, rigorous complication reporting, prospective multicenter data, cost analyses, and long-term functional follow-up are needed to benchmark and optimize care.