The use of robotic surgery for the management of urethral strictures and bladder neck contractures: A systematic review

The aim of this systematic review is to offer a comprehensive view of the current use of robotic surgery for the treatment of urethral strictures and bladder neck contractures. A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Embase databases in December 2023. Keywords used were “robotic” and “robotic-assisted” combined with “urethroplasty”, “urethral stricture”, and “bladder neck contracture”. All papers published after 2000, concerning studies conducted on humans for urethral strictures and bladder neck contractures managed with robotic surgery were considered for the review. Only procedures involving a direct approach to urethra/bladder neck and/or graft harvesting for urethroplasty have been included. A total of 275 articles were evaluated after the strategy search and only 11 articles were considered eligible for the final analysis. The studies included a series of between a minimum of 1 and a maximum of 104 patients, for a total of 203 patients. The robotic surgery was performed mainly for the treatment of bladder neck contracture and posterior urethra. In some reports, the robotic system was used for graft harvesting, subsequently used with an open perineal technique. The follow-up presented in the different studies is very heterogeneous. However, most studies have high success rates, with recurrence and redo surgery rates generally below 20%. Likewise, post-procedure incontinence rates are low. The outcomes presented in the literature, combined with the minimally invasive nature, suggest a possible growing role for robotic surgery in the coming years in the treatment of these diseases. El objetivo de esta revisión sistemática es ofrecer una visión general del uso actual de la cirugía robótica para el tratamiento de las estenosis uretrales y las contracturas del cuello vesical. Se realizó una revisión sistemática de la bibliografía actual a través de las bases de datos Medline y NCBI PubMed y Embase en diciembre de 2023. Las palabras clave utilizadas fueron «robotic» y «robotic-assisted» combinadas con «urethroplasty», «urethral stricture» y «bladder neck contracture». Se consideraron para la revisión todos los artículos publicados después de 2000, sobre estudios realizados en seres humanos para las estenosis uretrales y las contracturas del cuello vesical tratadas con cirugía robótica. Sólo se incluyeron los procedimientos con un abordaje directo de la uretra/cuello vesical y/o la obtención de injerto