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

Abstract

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). 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. 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. Short- and medium-term data shows the bladder flap posterior urethroplasty offers durable patency in recalcitrant BNC and VUAS with low morbidity.