The wider expansion of pediatric robotic urology: exploring the patterns of adoption in complex bladder reconstruction

Abstract Robotic surgery is increasingly used in pediatric urology, particularly for moderate-complexity procedures such as pyeloplasty and ureteral reimplantation. Whether this expansion has extended to high-complexity lower urinary tract (LUT) reconstruction remains unclear. To characterize global trends in robot-assisted appendicovesicostomy (APV), augmentation cystoplasty, and bladder neck reconstruction (BNR) between March 2016 and March 2025, and to evaluate changes in proportional robotic adoption. A systematic review of PubMed, Embase, and Scopus (PROSPERO CRD420251105224) identified English-language studies reporting robotic APV, augmentation cystoplasty, or BNR in patients ≤18 years. Eligible studies included case reports, case series, and comparative studies. Two reviewers independently extracted study characteristics, operative outcomes, and annual case volumes. Published epidemiologic data were used to estimate yearly global robotic adoption rates. Thirty-six publications comprising 329 robotic procedures were included: 192 APV (58%), 70 augmentation cystoplasties (21%), and 67 BNRs (20%). Annual case volumes fluctuated without a sustained upward trend. APV accounted for most reported procedures, with publication-year peaks in 2017, 2019, and 2025. Although overall pediatric robotic urologic volume increased nearly threefold between the historical and contemporary eras (3,688 vs. 10,907 cases), estimated robotic adoption for APV, augmentation cystoplasty, and BNR remained below 10% for every procedure across all years. Functional outcomes and complication rates were generally comparable to historical open series. Contemporary growth in pediatric robotic urology has been driven primarily by lower-complexity procedures, while adoption for complex LUT reconstruction remains limited. Broader implementation will require advances in technology, structured training, and resource allocation.