Robotic Transvesical Bladder Neck Reconstruction: A Novel Approach to Managing Vesicourethral Anastomotic Stenosis.

Abstract

Our aim was to investigate outcomes of a novel robotic transvesical approach for bladder neck reconstruction in the surgical management of vesicourethral anastomotic stenosis (VUAS). We performed a retrospective review of our single-institution database of robotic bladder neck reconstruction procedures to identify all consecutive patients who underwent robotic transvesical bladder neck reconstruction (RTV-BNR) for definitive management of VUAS between 2021 and 2024. The surgical technique involves circumferential excision of fibrotic scar tissue and creation of a mucosa-to-mucosa, watertight, tension-free anastomosis between the bladder neck mucosa and posterior urethra via a posterior transvesical approach. The primary outcome was surgical success, defined as patients who did not require any additional surgical reintervention for recurrent stenosis after the initial procedure. Secondary outcomes included de novo stress urinary incontinence (SUI) and major (Clavien grade >2) postoperative complications. Eleven patients met the inclusion criteria. Two patients (18%) had a history of salvage radiotherapy before RTV-BNR. All strictures were <2 cm in length. The median operative time was 189 min (interquartile range [IQR] 122-248) and median estimated blood loss was 100 ml (IQR 50-100). None of the patients developed de novo SUI. At median follow-up of 22 mo (IQR 14-30), the surgery was successful in ten patients (91%). Major limitations of the study are its retrospective nature, small sample size, and lack of a direct comparison to outcomes with established techniques for VUAS management. RTV-BNR is an innovative technique that may offer a safe and effective approach for VUAS management.