The outcomes of robot-assisted surgery in the treatment of neurogenic lower urinary tract dysfunctions: a systematic review and meta-analysis

Aims: To assess the outcomes of robotic surgery for patients with neurogenic lower urinary tract dysfunctions (NLUTD).

Materials and methods: 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.

Results: 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.

Conclusions: 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.