A Novel Standard or Evolution in Treatment? A Systematic Review with Insights from Single-Center Experience on Robot-Assisted Urachal Excision and Partial Cystectomy for Urachal Pathologies

Background: Ura-chal pathologies, while rare, pose a malignant transformation risk. RAUEPC is a mini-mally invasive technique with potential benefits, yet evidence remains limited. Methods: A systematic review was conducted in PubMed, Scopus, the Cochrane Library, and Sci-enceDirect (last search: 1 November 2024). Inclusion criteria: studies on RAUEPC for ura-chal pathologies. Exclusion criteria: non-robotic approaches or incomplete data. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the JBI Critical Appraisal Checklist for case reports. Descriptive statistics summarized continuous data (means, medians, 95% CIs), and chi-square tests analyzed associations between categori-cal variables. Heterogeneity analysis was infeasible, necessitating narrative synthesis. In-stitutional data (3 cases, 2021–2024) were included for comparison. Results: Forty-four studies (n = 145) met inclusion criteria. Benign lesions constituted 66.2% (95% CI: 59.1–73.3%) and malignant lesions 33.8% (95% CI: 26.7–40.9%). Mean operative time was 177.8 min (95% CI: 96.8–300), blood loss 83.3 mL (95% CI: 50–171), and hospital stay 3.9 days (95% CI: 1–10.9). Complications occurred in 33.3%. Institutional results showed a mean operative time of 85.3 min, blood loss of 216.7 mL, and no recurrences at 10.7 months’ fol-low-up. Discussion: RAUEPC appears to be a feasible and safe approach, showing prom-ising short-term outcomes. Associations between symptoms and diagnostic methods sug-gest its utility. Limitations include small sample sizes and retrospective designs. Registra-tion: PROSPERO: CRD42024597785. Funding: No external funding.