Abstract

Background Bladder cancer is a common malignancy in both sexes. Robot-assisted approaches are increasingly used in its surgical management. Radical cystectomy can significantly affect health-related quality of life (HRQoL), typically assessed using patient-reported outcome measures (PROMs) that capture patients’ physical, psychological, and social well-being. Objectives To systematically compare HRQoL and functional outcomes following robot-assisted versus open radical cystectomy (RARC vs. ORC) for bladder cancer, and to evaluate the methodologies employed, including PROMs and postoperative assessment timepoints. Methods A systematic search of CENTRAL, Embase, PubMed, and Scopus (2000–2025) was performed for randomised and non-randomised studies comparing HRQoL outcomes after RARC and ORC. Eligible studies reporting PROM-based HRQoL were included. Data were extracted on patient characteristics, PROMs, and outcome domains, and synthesised descriptively. Results Nine studies involving 1,575 patients met inclusion criteria. Seven HRQoL domains were identified, assessed using 18 PROMs; the EORTC QLQ-C30 was most frequently applied (n = 4). HRQoL was typically assessed at 3, 6, and 12 months, with only one study extending beyond 12 months. Functional assessment was limited: one study employed the Internation Index of Erectile Function (IIEF-5) for male erectile function, none assessed female sexual function, and one reported objective continence outcomes. Across studies, no statistically significant differences in HRQoL were observed between RARC and ORC. However, heterogeneity in PROMs, inconsistent outcome reporting, and high risk of bias limited comparability. Conclusions Current evidence does not demonstrate a HRQoL advantage of RARC over ORC. Standardisation of PROMs, consistent follow-up intervals, and inclusion of functional domains are essential to strengthen comparative evidence and inform the role of RARC as a potential new standard of care.