Robotic surgery has increasingly been adopted for complex reconstructive urologic procedures; however, multicenter data on its safety and feasibility remain limited. We report the initial outcomes of the International Urologic Research Society (IURES) Robotic Reconstructive Urology Special Interest Group (SIG), combining experiences from multiple centers and surgeons.

We retrospectively analyzed 69 patients who underwent robotic reconstructive urologic surgery across five centers performed by nine surgeons. Procedures included pyeloplasty, ureteroureterostomy , ureteroneocystostomy (UNC), augmentation ileocystoplasty, Y-V plasty, vesicovaginal fistula repair, UNC with psoas hitch, sacrocolpopexy, transvesical bladder neck stricture repair with lingual mucosa, and selected robotic reconstructive procedures. Demographics, operative time, estimated blood loss, length of hospital stay, and complications (Clavien–Dindo classification) were evaluated.

Median patient age was 42 years (range 6–76). Pyeloplasty was the most common procedure (n=37), performed for intrinsic obstruction or crossing vessels. Additional procedures included ureteroureterostomy (n=6), ureteroileal stricture repair following RARC with intracorporeal neobladder (n=4) & ileal loop (n=2), UNC for iatrogenic injury or stricture (n=6), augmentation ileocystoplasty (n=3), vesicovaginal fistula repair (n=3), Y-V plasty (n=2), transvesical bladder neck stricture repair (n=2), and several single-case reconstructive procedures. Operative time ranged from 28 to 297 minutes. Estimated blood loss was minimal in most cases (10–200 mL). Median hospital stay ranged from 2 to 5 days. No intraoperative conversions occurred, and no major complication (Clavien ≥III) was observed.

The findings indicate that robotic reconstructive urologic surgery can be safely implemented across different institutions and surgeons, covering a broad spectrum of procedures with consistently low morbidity. The absence of major complications and conversions suggests that robotic platforms may facilitate complex reconstructive techniques while maintaining perioperative safety. These early multicenter data support the reproducibility and generalizability of robotic reconstructive approaches.

This first multicenter experience of the IURES Robotic Reconstructive Urology SIG demonstrates that robotic reconstructive surgery across a wide range of procedures is safe and feasible, with low morbidity and short hospital stays. These findings provide a basis for future prospective studies and procedural standardization.