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All Journal The International Journal of Medical Science and Health Research The Indonesian Journal of General Medicine
Anita Arum Wijayatri
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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ROBOTIC FLEXIBLE URETEROSCOPY VERSUS CONVENTIONAL FLEXIBLE URETEROSCOPY FOR THE MANAGEMENT OF RENAL CALCULI: EFFICACY, SAFETY, AND COST EFFICIENCY A SYSTEMATIC REVIEW Anita Arum Wijayatri; John M.Sangkai
The Indonesian Journal of General Medicine Vol. 37 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/fge2ym11

Abstract

Introduction: Robotic flexible ureteroscopy (R-fURS) has been developed to overcome ergonomic and technical limitations of conventional flexible ureteroscopy (C-fURS) for renal calculi. This systematic review compares the efficacy, safety, and cost efficiency of R-fURS versus C-fURS. Methods: A systematic search of PubMed, Scopus, Cochrane Library, Web of Science, and ClinicalTrials.gov (up to April 2026) was conducted following PRISMA 2020 guidelines. Risk of bias was assessed using RoB 2 (RCT) and ROBINS-I (observational studies). Certainty of evidence was evaluated using GRADE. Meta-analysis was not performed due to clinical and methodological heterogeneity. Results: Four studies comprising 518 patients were included: one head-to-head RCT (Geavlete 2016, N=132) and three single-arm R-fURS studies (Salah 2024, Kim 2025, Klein 2021). R-fURS stone-free rates ranged 73–92.4%, comparable to C-fURS (89.4% in direct comparison). Major complications (Clavien-Dindo ≥III) were 0–1%. Operative time ranged 51–116 minutes; length of stay was 9.3 hours–1.5 days. No study reported explicit cost data. Consistent advantages of R-fURS included improved surgeon ergonomics and reduced radiation exposure. Overall GRADE certainty: Very Low to Low. Discussion: R-fURS achieves comparable stone-free rates and safety to C-fURS, with superior ergonomics and radiation protection as its most robust benefits. However, evidence is limited by heterogeneity in stone-free rate definitions, lack of direct comparative data, and absence of cost-effectiveness analyses. Conclusion: R-fURS is a feasible alternative to C-fURS with acceptable efficacy and safety. Large-scale multicentre RCTs with standardised outcomes and formal cost analyses are required before strong clinical recommendations can be made.
Orthotopic Neobladder vs. Ileal Conduit after Radical Cystectomy: A Systematic Review on Functional Outcomes and Quality of Life Anita Arum Wijayatri; John M.Sangkai
The International Journal of Medical Science and Health Research Vol. 45 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/8apnrw20

Abstract

Introduction: Radical cystectomy (RC) for bladder cancer necessitates urinary diversion, with orthotopic neobladder (ONB) and ileal conduit (IC) being the main options. This review aims to identify and synthesize the statistically significant positive functional outcomes and quality of life (QoL) advantages of ONB compared to IC. Methods: A systematic review of 80 studies (RCT, etc) was conducted. Significant positive outcomes favoring ONB were extracted for global QoL, physical function, body image, sexual function, and specific QoL domains. Results: Meta-analyses demonstrated ONB significantly outperforms IC in global health status (WMD +9.13, p=0.004), physical functioning (WMD +11.57, p=0.0001), role functioning (WMD +9.64, p=0.002), and social functioning (WMD +6.81, p=0.03) (1,2). ONB showed superior body image (p=0.001) (12) and sexual function in males (p<0.001) (13,14). At 24 months, ONB achieved higher general HRQoL (73.6 vs. 60.5, p=0.013) and a greater proportion of "good" HRQoL (61.1% vs. 32.4%, p=0.019) (8). In women, ONB provided better emotional (p=0.02), physical (p=0.05), and role functioning (p=0.03) at 6 months (29). ONB also preserved better renal function compared to IC in some metabolic studies (39). Discussion: The positive significant effects of ONB are domain-specific and time-dependent. The advantage in global and physical functioning is most pronounced at 12-24 months post-surgery, corresponding to the stabilization of continence and anatomical preservation. Superior body image and male sexual function represent key psychosocial benefits not achievable with IC. However, these positive findings must be contextualized within significant selection bias favoring younger, healthier patients for ONB. Conclusion: ONB provides statistically significant and clinically meaningful advantages in global QoL, physical and social functioning, body image, and male sexual function. These positive outcomes support ONB as the preferred diversion for appropriately selected patients, particularly younger, motivated males without significant comorbidity.
Co-Authors John M.Sangkai