Division of Neuro-Urology, Department of Surgical Sciences, Citta della Salute e della Scienza University Hospital, Via Gianfranco Zuretti 24, 10143, Turin, Italy.
Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
World J Urol. 2024 Nov 7;42(1):631. doi: 10.1007/s00345-024-05312-7.
To assess the outcomes of robotic surgery for patients with neurogenic lower urinary tract dysfunctions (NLUTD).
Studies evaluating the outcomes (efficacy and safety) of robot-assisted ileal conduit creation or artificial urinary sphincter (R-AUS) implantation or augmentation cystoplasty or continent urinary diversion creation in patients with NLUTD were included. The search strategy and studies selection were performed on Medline, Embase and Cochrane using the PICOS method according to the PRISMA statement (PROSPERO 2022 CRD42022333157). The comparator, if available, was the use of open or laparoscopic technique. Meta-analysis was performed whenever possible. The remaining articles were synthesized narratively.
Eight articles were included. Five described the outcomes of robot-assisted cystectomy with ileal conduit creation, two described the outcomes of augmentation cystoplasty and continent urinary diversion creation and one described R-AUS implantation in patients with NLUTD. The risk of bias was high. Three articles comparing the outcomes of robotic and open cystectomy and ileal conduit creation were suitable for meta-analysis. According to our meta-analysis, robot-assisted surgery had better outcomes compared to open surgery in terms of high-grade early postoperative complications (OR 0.39; 0.19-0.79; p = 0.01), days to bowel recovery (Cohen's D = - 0.62 ± 0.14, p < 0.001), length of hospitalisation (Cohen's D = - 0.28 ± 0.13; p = 0.03) and estimated blood loss (Cohen's D = - 1.17 ± 0.14, p < 0.001).Regarding AUS implantation, augmentation cystoplasty and continent urinary diversion creation, the outcomes from the articles included in our systematic review showed a 16-40% overall early complication rate in case of augmentation cystoplasty and 22% in case of AUS implantation.
Robot-assisted surgery may have several advantages over open surgery in the treatment of NLUTDs. However, current evidence is insufficient to draw firm conclusions. Further high-quality studies are needed to better understand the role of robotic surgery in the treatment of NLUTD.
评估机器人手术治疗神经源性下尿路功能障碍（NLUTD）患者的效果。
本研究纳入了评估机器人辅助回肠通道造口术或人工尿道括约肌（R-AUS）植入术或增强型膀胱扩大术或可控性尿流改道术治疗 NLUTD 患者的结局（疗效和安全性）的研究。检索策略和研究选择均根据 PRISMA 声明（PROSPERO 2022 CRD42022333157）在 Medline、Embase 和 Cochrane 上使用 PICOS 方法进行。如果有对照，则使用开放或腹腔镜技术。只要有可能，就进行荟萃分析。其余的文章则进行叙述性综合。
纳入了 8 篇文章。其中 5 篇描述了机器人辅助膀胱切除术和回肠通道造口术的结局，2 篇描述了增强型膀胱扩大术和可控性尿流改道术的结局，1 篇描述了 NLUTD 患者的 R-AUS 植入术的结局。偏倚风险较高。有 3 篇比较机器人和开放膀胱切除术和回肠通道造口术的结局的文章适合进行荟萃分析。根据我们的荟萃分析，与开放手术相比，机器人辅助手术在高级别术后早期并发症（OR 0.39；0.19-0.79；p=0.01）、肠道恢复时间（Cohen's D=-0.62±0.14，p<0.001）、住院时间（Cohen's D=-0.28±0.13；p=0.03）和估计失血量（Cohen's D=-1.17±0.14，p<0.001）方面具有更好的结局。关于 AUS 植入术、增强型膀胱扩大术和可控性尿流改道术，纳入本系统评价的文章的结局显示，增强型膀胱扩大术的总体早期并发症发生率为 16-40%，AUS 植入术的早期并发症发生率为 22%。
机器人辅助手术在治疗 NLUTD 方面可能优于开放手术。然而，目前的证据还不足以得出明确的结论。需要进一步开展高质量的研究，以更好地了解机器人手术在治疗 NLUTD 中的作用。
