Robotic approach to pediatric augmentation cystoplasty: Feasibility, long-term outcomes, and technical refinements.

Introduction: Pediatric bladder dysfunction refractory to conservative management poses significant risks to renal function. While open augmentation cystoplasty is the standard for surgical intervention, robotic-assisted techniques offer a minimally invasive alternative. This study evaluates our institutional experience with robotic augmentation cystoplasty in children, focusing on technical modifications, perioperative outcomes, and long-term functional results.

Patients and methods: This prospective series included 11 children who underwent robotic augmentation cystoplasty between January 2014 and December 2023. All had small-capacity, high-pressure bladders unresponsive to anticholinergics, clean intermittent catheterization, and/or intravesical botulinum toxin injection. Preoperative workup included ultrasonography, dimercaptosuccinic acid scans, and videourodynamic studies. A standardized technique using a detubularized ileal U-pouch and bladder bivalving was performed using the da Vinci Si/Xi system. Concomitant procedures included ureteric reimplantation and Mitrofanoff appendicovesicostomy in select cases. Outcomes assessed included operative parameters, urodynamic changes, complication rates, and long-term renal function.

Results: All surgeries were completed robotically without conversion. The mean age at surgery was 8.4 years (range: 2-15 years). Mean operative time was 355.5 min and mean estimated blood loss was 294.5 ml. Concomitant ureteric reimplantation was performed in 6 patients and Mitrofanoff creation in 1 patient. Mean bladder capacity improved from 86.4 ml to 283.6 ml (mean increase 383 %), and mean detrusor pressure decreased from 57.5 cm H₂O to 21.8 cm H₂O (62.1 % reduction). There were no major complications. Over a mean follow-up of 74 months, all patients reported improved continence and stable upper tract outcomes.

Conclusion: Robotic augmentation cystoplasty is a safe, effective, and durable alternative to open surgery in well-selected pediatric patients. Long-term outcomes demonstrate significant functional improvement. Our selective approach to Mitrofanoff creation may minimize morbidity while preserving surgical success.