V01-09: Robotic Y-V plasty for Recalcitrant Bladder Neck Contracture
Open surgical reconstruction of recalcitrant bladder neck contracture (BNC) is difficult to perform due to poor exposure. Robotic assistance facilitates bladder neck reconstruction through enhanced dexterity and visualization. We demonstrate the technique and the outcomes of robot assisted Y-V plasty bladder neck reconstruction (RYVBNR).
We present our technique for treatment of BNCs in seven patients who underwent RYVBNR at our institution between March 2016 and September 2017. Indication for the procedure was incomplete emptying, recurrent urinary tract infections and dysuria. On follow-up, patients were assessed for clinical success by absence of infections, symptoms and cystoscopic evaluation. Robotic assisted dissection is performed to open the space of Retzius and mobilize the bladder. The cystoscope is passed to the level of the BNC, and FireflyTM technology is used to localize the BNC. The BNC is incised anteriorly, and a V-shaped bladder flap is advanced into the BNC in a Y-V plasty fashion. We place a perioperative closed suction drain, which is removed before discharge, and a 22 Fr catheter which will be removed in the office at approximately two weeks.
Seven men developed recalcitrant BNCs. Patients had previously undergone an endoscopic procedure. Median time for last attempt at endoscopic management to RYVBNR was 4.7 months. The average number of prior attempts at endoscopic management was 2. All patients underwent RYVBNR without conversion to open surgery. The median operative time was 240min, estimated blood loss was 67 ml, and length of stay was 1 day. There were no intraoperative complications. Catheters were removed in the office at a median time of 15 days. At a median follow-up of 8 months, all cases were successful with no evidence of recurrence (Table 1). Only two patients had persistent urinary incontinence at 1 pad per day.
RYVBNR with a Y-V plasty is a feasible, and effective technique for managing the difficult reconstructive problem of recalcitrant BNC.