Robotic Transvesical Bladder Neck Reconstruction: A Novel Approach to Managing Vesicourethral Anastomotic Stenosis.
Publication/Presentation Date
11-1-2025
Abstract
BACKGROUND AND OBJECTIVE: 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).
METHODS: 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.
KEY FINDINGS AND LIMITATIONS: 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.
CONCLUSIONS AND CLINICAL IMPLICATIONS: RTV-BNR is an innovative technique that may offer a safe and effective approach for VUAS management.
Volume
88
Issue
5
First Page
519
Last Page
524
ISSN
1873-7560
Published In/Presented At
Lee, M., Lesgart, M., McPartland, C., Lee, R., & Eun, D. D. (2025). Robotic Transvesical Bladder Neck Reconstruction: A Novel Approach to Managing Vesicourethral Anastomotic Stenosis. European urology, 88(5), 519–524. https://doi.org/10.1016/j.eururo.2025.04.026
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40393860
Department(s)
Administration and Leadership
Document Type
Article