Ahmad Ihtisham, Alshammari Dheidan, Yadav Priyank, Chua Michael, Chancy Margarita, Ansari Mohd S, Gundeti Mohan S
Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Division of Urology, New Jahra Hospital, Al Jahra, Kuwait.
BJU Int. 2025 Apr;135(4):557-566. doi: 10.1111/bju.16658. Epub 2025 Jan 28.
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.
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.
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.
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.
在一项系统评价中评估机器人辅助手术治疗小儿神经源性下尿路功能障碍（LUTD）的结果、益处和局限性，因为机器人辅助技术已成为一种潜在的替代方法，具有更高的精准度、灵活性和可视化效果。
本评价已在国际前瞻性系统评价注册库（PROSPERO标识符CRD42023464849）中注册，并遵循系统评价和Meta分析的首选报告项目指南。我们纳入了患有神经源性LUTD且接受机器人辅助控尿手术的儿科患者（年龄<18岁）的研究，评估安全性和有效性。在医学文献分析和检索系统在线数据库（MEDLINE）、医学文摘数据库（EMBASE）和Scopus中进行文献检索，直至2024年7月12日。数据提取包括手术程序、并发症、手术时间、住院时间和膀胱功能结果。
共纳入42项研究（20例病例报告、10例病例系列、6例队列研究、6例比较队列研究）。用于可控性导尿通道构建、膀胱扩大术和膀胱颈重建的机器人手术显示出相似的围手术期和术后结果。对五项比较机器人辅助与开放阑尾膀胱造口术的研究进行Meta分析表明，机器人组的住院时间显著缩短，而手术时间、并发症和再次干预率无显著差异。转为开放手术的情况很少见，在通道构建过程中表现为粘连或阑尾较小。
机器人辅助手术治疗小儿神经源性LUTD显示出潜在益处，包括缩短住院时间，在某些情况下并发症发生率与开放手术相当。然而，现有证据受到研究设计的异质性、样本量小和单中心经验的限制，这限制了其普遍性。对并发症和结果进行标准化报告以及开展多中心研究，对于阐明这些技术的长期疗效和更广泛的适用性至关重要。
