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Words of Wisdom

Re: Perioperative and Short-term Outcomes of Robotic

vs Open Bladder Neck Procedures for Neurogenic


Grimsby GM, Jacobs MA, Menon V, Schlomer BJ, Gargollo PC.

J Urol 2016;195:1088–92

Expert’s summary:

The authors retrospectively compared open (O-BNR;


= 26)

and robotically-assisted bladder neck reconstruction



= 19) without bladder augmentation in a

pediatric population, with a mean age at surgery of 9.1 yr


. The indication for surgery in this pediatric series of

45 patients was refractory neurogenic urinary incontinence.

The mean follow-up was 2.8 yr for surgeries performed

between 2010 and 2014. The most frequent underlying

cause of neurogenic refractory incontinence was spina

bifida (34/45 cases). A sling-type BNR was performed in all

cases. The results were comparable for both cohorts,



any significant difference regarding outcome,

except for a longer operative time in the RA-BNR group.

The authors conclude that the two techniques are

comparable except for operative time.

Expert’s comments:

Over the last decade, robotics has become a new challenge

in the pediatric population, as the very limited working

space imposes some limits. Initial adaptation of robotics for

children was applied in common procedures such as

pyeloplasty and ureteral reimplantation


. More complex

procedures such as bladder augmentation and BNR still

need to be evaluated in large series. However, even in

tertiary referral centres, indications for this type of surgery

remains limited and is decreasing with the advent of new

classes of anticholinergic agents and injection of intrave-

sical botulinum toxin



Patients with a spina bifida condition would clearly

benefit from minimally invasive surgery such as RA-BNR.

This population is prone to frequent hospital stays,

prolonged ileus, wound dehiscence, and infection. If

minimally invasive surgery had indeed, as suggested by

the authors, at least equivalent outcomes regarding

continence, it would offer important benefits. It is very

likely that operative time will decrease as experience

increases, so hospital stay length and immediate postoper-

ative complications will probably decreas. Larger series are

needed to prove that incisional-related complications are

likely to be reduced in this difficult patient population

compared to O-BNR, probably offering pediatric patients

with spina bifida an important benefit



Whether the costs of the minimally invasive techniques

such as robot-assisted surgery will be counterbalanced by

lower complication-related expenses in this pediatric

population remains to be evaluated. If the cost of robot-

assisted procedures decreases with new providers in the

future, RA-BNR would certainly become the procedure of


Conflicts of interest:

The author has nothing to disclose.



Grimsby GM, Jacobs MA, Menon V, Schlomer BJ, Gargollo PC. Peri- operative and short-term outcomes of robotic vs open bladder neck procedures for neurogenic incontinence. J Urol 2016;195:1088–92



Spinoit A-F, Subramaniam R. Update on the minimally invasive approach in paediatric urology: remote help for human hands? Eur Urol Suppl 2015;14:20–4



Cohen AJ, Pariser JJ, Anderson BB, Pearce SM, Gundeti MS. The robotic appendicovesicostomy and bladder augmentation: the next frontier in robotics, are we there? Urol Clin N Am 2015;42:121–30



Gundeti MS, Petravick ME, Pariser JJ, et al. A multi-institutional study of perioperative and functional outcomes for pediatric robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy. J Pediatr Urol 2016;12, 386.e1–5


Anne-Franc¸ oise Spinoi

t *

Department of Urology, Ghent University Hospital, Ghent, Belgium

*Department of Urology, Ghent University Hospital, De Pintelaan 185,

Ghent 9000, Belgium.

E-mail address: .


2017 European Association of Urology.

Published by Elsevier B.V. All rights reserved.

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