Objective
To review a robotic approach to recalcitrant bladder neck obstruction and to assess
success and incontinence rates.
Materials and Methods
Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic
stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified.
We reviewed patient demographics, medical history, etiology, previous endoscopic management,
cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture
success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible
cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1
pad per day or procedures for incontinence.
Results
Between 2015 and 2017, 12 patients were identified who met study criteria and underwent
RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy
in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean
estimated blood loss of 85 cc (range 5-200 cc). Median length of stay was 1 day (range
1-5 days). Three of 12 patients had recurrence of obstruction for a 75% success rate.
Additionally, 82% of patients without preoperative incontinence were continent with
a median follow-up of 13.5 months (range 5-30 months). There was 1 Clavien IIIb complication
of osteitis pubis and pubovesical fistula that required vesicopubic fistula repair
with pubic bone debridement.
Conclusion
RBNR is a viable surgical option with high patency rates and favorable continence
outcomes. This is in contrast to perineal reconstruction, which has high incontinence
rates. If future incontinence procedures are needed, outcomes may be improved given
lack of previous perineal dissection.
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Article info
Publication history
Published online: May 17, 2018
Accepted:
May 3,
2018
Received:
February 5,
2018
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
