V05-03: Robotic Reconstruction for Recalcitrant Post-Prostatectomy Vesicourethral Anastomosis Stenosis: Video Case Series
Post-prostatectomy vesicourethral anastomosis stenosis (VUAS) that is refractory to endoscopic management traditionally has required open reconstruction with invasive measures such as combined abdominoperineal approach and pubectomy. A robotic technique offers potential advantages of smaller incisions, excellent visibility, near infrared fluorescence, dexterity within the deep aspects of the pelvis, and sparing of the perineal planes.
We reviewed our experience of VUAS robotic reconstructions at our institution by a single surgeon over the past year. We tabulated patient characteristics, preoperative workups, operative approaches, and short-term outcomes and present these, with emphasis on operative techniques, in this video series.
We present four patients who underwent robotic reconstruction for post-prostatectomy VUAS between 2017 and 2018. They had failed a range of 2 to 6 endoscopic treatments. Three of the four had obliterative stenoses and were treated with a transecting repair, while the last had a non-occlusive stenosis that was repaired with Y-V plasty. We emphasize techniques such as development of the plane posterior to the bladder, near infrared fluorescence to guide identification of urethra and bladder neck, and traction sutures to facilitate the vesicourethral anastomosis. None of our patients experienced recurrence of stenosis to date and two had restoration of continence, one inherently and one via artificial genitourinary sphincter.
Robotic reconstruction is a viable approach to recalcitrant VUAS with several potential benefits including a less invasive approach, improved visibility and dexterity in the pelvis, and sparing of the perineal planes to promote opportunities for restoration of continence.