Robotic reconstruction of complex bladder neck stenosis: Single-centre experience with three techniques

Abstract

Objectives

To evaluate and compare surgical techniques for robot-assisted reconstruction of recurrent bladder neck stenosis (BNS). BNS following a simple prostatectomy represents a rare but challenging condition in operative urology. Various robotic reconstructive techniques have been described, showing differing success rates. This monocentric case series reports on three distinct robotic surgical approaches for managing recurrent BNS.

Patients and methods

A retrospective analysis was conducted on patients undergoing robot-assisted surgical repair for recurrent BNS at our institution. Clinical data, including patient history, comorbidities (Charlson Comorbidity Index), surgical treatment, complications (Clavien-Dindo classification) and follow-up outcomes, were analysed.

Results

A total of 27 patients underwent robotic bladder neck reconstruction for recurrent BNS. Twelve patients were treated with YV plasty, 12 with stricture resection and end-to-end anastomosis and 3 with reconstruction using a buccal mucosa graft (BMG). At a median follow-up of 18 months, therapy failure occurred in 9 patients (33.3%), with failure rates of 25.0% for YV plasty, 33.3% for stricture resection and 66.7% for BMG plasty. Nine patients (33.3%) experienced surgery-related complications, including 7 minor complications (5 in the stricture resection group, 1 in the YV plasty group and 1 in the BMG group) and 2 major complications (1 in the stricture resection group and 1 in the YV plasty group). De novo incontinence occurred in five patients (19.2%), all of whom had undergone stricture resection with end-to-end anastomosis.

Conclusions

Recurrent BNS poses a significant surgical challenge. Based on our experience, BMG reconstruction demonstrated suboptimal outcomes, while stricture resection was associated with the highest complication rate and the most frequent occurrence of de novo incontinence. YV plasty, with its relatively low morbidity and minimally invasive nature, has become the preferred technique in our institution for managing this condition. Prospective studies with larger cohorts are warranted to confirm these findings and further refine surgical approaches.