Hybrid endoscopic-robotic approaches for complex upper urinary tract disorders: a systematic review and single-arm...

Complex upper urinary-tract disorders (CUUTD) pose challenges owing to multifactorial etiology. Evidence on hybrid endoscopic-robotic approaches (HERA) remains limited. We evaluated the efficacy, safety, and outcomes of HERA for CUUTD across adult and pediatric populations. We performed a PRISMA-compliant systematic review and single-arm meta-analysis of pooled proportions (Freeman-Tukey transformation) registered in PROSPERO (CRD420251022229). PubMed, Scopus, Web of Science databases were searched for English full-texts only (last searched: June 22, 2025). Inclusion criteria were: randomized controlled trials (RCTs) and non-randomized studies using HERA for CUUTD. Exclusion criteria were: isolated pathologies, single-modality, non-English, and insufficient data. Populations were grouped as adult, pediatric, or mixed. The independent dual review and risk of bias (RoB) assessment used Joanna Briggs Institute checklists. Heterogeneity (I²) and publication bias (Egger's test) were evaluated. Fourteen retrospective studies (2005-2023) from international centers (n = 95: 26 adults, 44 pediatric, and 25 mixed populations; low bias) were included. In the absence of comparator arms, our findings represent descriptive pooled estimates of efficacy and safety. Pooled stone-free rate was 90.3% (95% CI 82.9-95.8%; I² = 75.8%%) and was higher in adults (100%) than in pediatrics (81.8%; p = 0.0082). Obstruction resolution was 100%; although no intraoperative complications were observed, postoperative complications were noted in 11.6% cases, mostly Clavien-Dindo II-IIIa. The reoperation rate was 9.6%, mean operative time was 185.2 min, and the mean hospital stay was 3.5 days. Stone recurrence and obstruction recurrence were noted in 4.2% and 0% cases, respectively. In selected patients and experienced centers, HERA may achieve high SFR and obstruction resolution with acceptable morbidity; however, the overall strength of evidence is low, heterogeneity is substantial, and publication bias was detected. Findings are preliminary and hypothesis-generating. Rigorous prospective comparative studies with standardized outcome definitions and follow-up are needed before drawing firm practice-changing conclusions.