Robotic bladder flap posterior urethroplasty for recalcitrant bladder neck contracture and vesicourethral anastomotic stenosis

Abstract

Objective: To describe the technique and surgical outcomes in a case series of patients undergoing robotic bladder flap posterior urethroplasty for recalcitrant bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). Patients and surgical procedure: Our technique involves creation of a vesicourethral anastomosis (VUA) from an anterior bladder wall flap for repair. The bladder neck is first transected and dystrophic tissue is excised. A cystotomy is created in the anterior bladder wall which is anastomosed to the urethral stump to form a VUA. Demographic, procedural and follow-up data was retrospectively collected from 9 patients who underwent the procedure. Results: Average operative time was 295.5 min in all patients and 264.5 min excluding three patients who had ancillary procedures. There were no intraoperative complications and two 30-day postoperative complications. At a mean follow up time of 21.1 weeks, 78% of patients (7/9) had no recurrent stricture. Both patients with recurrent stricture underwent subsequent balloon dilation, and at a mean post-dilation follow up of 14.5 weeks, one patient remained patent. Of the three patients without pre-operative stress urinary incontinence (SUI), none developed de-novo SUI. Conclusions: Short- and medium-term data shows the bladder flap posterior urethroplasty offers durable patency in recalcitrant BNC and VUAS with low morbidity.

Keywords

• Posterior urethroplasty
• Bladder neck contracture
• Vesicourethral anastomotic stenosis