V01-01: Robotic Posterior Urethroplasty for Radiation Induced Posterior Urethral Stenosis
Posterior urethroplasty for radiation induced urethral stenosis may result in urinary incontinence, and the urethral mobilization can compromise artificial urinary sphincter outcomes. Robotic posterior urethroplasty (RPU) for posterior urethral stenosis (PUS) is a transabdominal approach that prioritizes mobilization of the bladder and prostate instead of urethral mobilization. For patients with PUS isolated to the prostatic or membranous urethra, reconstruction can be performed without perineal dissection or transection of the bulbar arteries.
We present our technique for treatment of PUS in four patients who underwent RPU for radiation induced PUS at our institution between July 2015 and June 2017. On follow-up, patients were assessed for clinical success by absence of infections, symptoms and cystoscopic evaluation. Following port placement and docking of the robot, the posterior bladder and prostate are mobilized and the cystoscope is advanced to the level of the PUS. We combined cystoscopic guidance and near infrared fluorescence imaging (FireflyTM) technology to localize the PUS. The stenotic urethral segment is excised and primary anastomosis is performed.
Four men presented with PUS after RT for pCA (Table 1). The median time from radiation therapy to RPU was 120 months. All men had failed previous endoscopic treatment of PUS. All patients underwent RPU without conversion to open surgery or perineal urethral mobilization. The median operative time was 282 min, EBL was 75 ml and LOS was 1 days. There were no intraoperative complications. All patients had a successful operation with no recurrence at a median follow up time of 4 months.
Robotic repair of radiation induced PUS is a feasible and effective technique for managing RT induced PUS.