Robot-Assisted Bladder Neck Reconstruction in Refractory Vesicourethral Anastomotic Stenosis - A Single-Center Experience from a Specialized Urinary Tract Repair and Reconstruction Center

Abstract

OBJECTIVE: To investigate the efficacy and safety of robotic-assisted bladder neck reconstruction in patients with refractory vesicourethral anastomotic stenosis (VUAS) following radical prostatectomy (RP) or radical cystectomy (RC) with orthotopic neobladder (ONB) reconstruction. METHODS: The clinical data from patients with VUAS who underwent robot-assisted bladder neck reconstruction at our center from August 2022 to February 2025 were retrospectively analyzed. The minimum postoperative follow-up period was 3 months, and bladder neck patency was defined as either the passage of a F16 flexible cystoscope or a maximum urinary flow rate (Qmax)>15 mL/s. RESULTS: A total of 27 patients were analyzed, including 25 with a history of RP and 2 with a history of RC with ONB reconstruction. The median operative time was 210 min (interquartile range [IQR]:168-259), with a median estimated blood loss of 152 mL (IQR: 80-255) and a median postoperative hospital stay of 3.5 d (IQR: 3-6 d). At the median follow-up of 11 months (IQR: 3-34), 20 patients (74.1%) achieved patent reconstruction and 9 patients (75%) remained continent in 12 patients without preexisting stress urinary incontinence (SUI) at last follow-up. Postoperative complications occurred in five patients (18.5%), including two cases of Clavien-Dindo grade Ӏ and three cases of grade ӀӀ. CONCLUSIONS: Robotic-assisted bladder neck reconstruction represents a safe and effective surgical option with high patency and low de novo SUI rates for refractory VUAS following RP or RC with ONB reconstruction.