V01-11: Robotic Bladder Neck Reconstruction for Post-Prostatectomy Bladder Neck Contracture
In this video we will demonstrate robotic reconstruction of a bladder neck contracture. The patient is a 61 year old male who underwent a robotic prostatectomy for Gleason 3+4=7 prostate cancer. His post-operative course was complicated by an anastomotic leak and then immediate urinary retention after initial catheter removal. He required prolonged post-operative catheter placement for one month. He then developed recurrent bladder neck contractures requiring a DVIU and subsequently a transurethral bladder neck resection. Both of these interventions were successful for less than one month in duration. He was referred for consideration of definitive bladder neck reconstruction.
The patient was counseled on his options and elected to pursue robotic surgery. We explained the rare indication for this type of surgery and expected significant post-operative incontinence and erectile dysfunction.We performed a robotic bladder neck reconstruction using standard robotic prostatectomy port placement, proceeding with circumferential bladder neck reconstruction.
The patient tolerated the procedure, which lasted 4.5 hours, very well. His catheter was removed at 2 weeks. At the time of his 8 week follow-up, he reported a satisfactory stream while requiring only 1 pad per day for SUI. Cystoscopy at 4 months demonstrated a patent bladder neck without recurrence of contracture. At 9 months after the operation he has excellent voiding without significant incontinence.
The standard treatment of recalcitrant bladder neck contractures is an open repair. However, a novel minimally-invasive approach has been described to include a small robotic series using a Y-V advancement flap technique. To our knowledge, this is the first description of a robotic bladder neck reconstruction by circumferential excision and re-approximation. This technique appears to be useful in select circumstances such as bladder neck contracture after robotic prostatectomy. Keys for success include adequate scar tissue excision, mucosal to mucosal apposition, and a tension free and water tight anastomosis.