Comparative outcomes of open and robotic ureteral reimplantation in children with vesicoureteral reflux: A systematic review and meta-analysis

Aim: Open ureteral reimplantation (OUR) is the benchmark for vesicoureteral reflux (VUR). Robotic-assisted laparoscopic ureteral reimplantation (RALUR) has emerged as a minimally invasive alternative, offering potential advantages in recovery, though with more variable reported outcomes. We compared OUR and RALUR in children, focusing on success, complications, length of stay, and analgesia. Methods: PRISMA-guided systematic review and meta-analysis of comparative pediatric studies (PubMed, Cochrane Library, Web of Science; 1 January 2010–31 March 2025). Results: Eight retrospective studies met criteria (n = 546; 249 OUR, 297 RALUR). OUR included intravesical and extravesical repairs; RALUR was predominantly extravesical. Mean age/weight were 5.1 years/19.4 kg (OUR) and 7.2 years/26.5 kg (RALUR); mean VUR grade was 3.2 in both groups. Operative time was shorter for OUR (143 vs 193 min), but hospital stay was longer (2.5 vs 1.5 days). Early postoperative complications occurred in 19.1 % (OUR) and 16.6 % (RALUR). Analgesic requirements were lower after RALUR (0.14 vs 0.33 mg/kg morphine equivalents). At a median 15.1-month follow-up, success was 92.5 % (OUR) and 94.1 % (RALUR). Meta-analysis showed no difference in complications (7 studies, n = 434; OR 0.80, 95 % CI 0.32–1.97; p = 0.56; I2 = 23.7 %) or success (7 studies, n = 433; OR 1.22, 95 % CI 0.42–3.55; p = 0.67; I2 = 0 %). Conclusions: RALUR appears to be a safe, feasible alternative to OUR for pediatric VUR, with comparable success and complication rates, shorter hospital stay, and longer operative time. Limitations include heterogeneity in surgical techniques and baseline age differences between cohorts.