Long-term surgical outcomes of robotic versus open bladder neck reconstruction in a pediatric population

Robotic bladder neck procedures may offer unique benefits including improved visualization and suturing dexterity compared to an open approach. Our aim was to compare the short and long-term clinical outcomes of pediatric patients undergoing robotic versus open bladder neck reconstruction with slings at a single institution.

A retrospective review was performed of pediatric patients with neurogenic bladders undergoing robotic or open bladder neck reconstruction with slings between January 2015-July 2024. All open procedures were performed by one of three surgeons, and all robotic procedures were performed by one of two surgeons at a single institution. Patient demographics, intra-operative, and post-operative outcomes were collected and compared using Fischer's exact and Wilcoxon rank-sum tests, as appropriate. A p-value of ≤0.05 was considered statistically significant.

A total of 59 patients were identified (22 robotic and 37 open), with a median follow-up length of 5.5 years (interquartile range: 2.7-7.5 years). The robotic group had a significantly longer operative time (457.5 vs 275.0 min, p = 0.01). There was no significant difference in continence rates (86% vs 89% p = 1.00), 30-day complication rates (41% vs 38%, p = 1.00) or surgical revision rates (36% vs 46%, p = 0.80) between the robotic and open groups. The robotic group had a significantly shorter hospital stay even when excluding patients who underwent a concomitant augment or Monti creation (5.0 vs 8.0 days, p = 0.01).

Robotic bladder neck reconstruction in a pediatric population is feasible with similar post-operative outcomes compared to an open approach with the benefit of significantly shorter hospital stays.