V10-02: Robot-assisted laparoscopic YV-plasty in patients with refractory bladder neck contracture

Video

Introductions and Objectives
In most cases bladder neck contracture (BNC) in the adult male patient is iatrogenic following transurethral resection of the prostate, radical prostatectomy or pelvic irradiation. While there is general agreement on initial treatment comprising endoscopic procedures like balloon dilation, bladder neck incision and bladder neck resection there is little evidence on the management of complex refractory BNC. We present a case series of patients with refractory BNC treated with robot-assisted laparoscopic YV-plasty of the bladder neck (RAYV).

Methods
Between 01/2013 and 03/2014 4 consecutive male patients underwent RAYV in our clinic. In 3 cases BNC emerged after transurethral resection of the prostate and in 1 case after retropubic simple prostatectomy. Each patient had 3 unsuccessful previous endoscopic treatments. Data were collected retrospectively using the patient’s charts and questionnaires were sent to the patients.

Results
The surgical technique of RAYV is illustrated and described in our video. All procedures were performed using a transperitoneal six-port approach (four-arm robotic setting) with the patients in a steep Trendelenburg position. First, cystoscopy is performed to determine the relationship between BNC and urethral sphincter. Then, the peritoneum is incised medially and the bladder is approached as for cystostomy. After removal of the prevesical fat, the bladder neck is identified. Then the Y incision is performed through all layers with cold scissors. Thereafter, interrupted sutures are placed in the way that the apex of the V-flap is brought to the base of the Y incision, so that a wide bladder neck is accomplished. There were no intraoperative complications. Furthermore, no major postoperative complications according to the Clavien-Dindo classification occurred. 2 patients experienced minor complications within 90 days of surgery (1x grade I, 1x grade II). The postoperative hospital stay ranged from 8 to 14 days. During follow-up (range 4,2-17.5 months) all 4 patients maintained a subjectively unimpaired voiding function. No case of refractory BNC or de novo stress urinary incontinence was observed. 1 patient with preexisting stress urinary incontinence underwent a successful transobturator male sling procedure 4 months after RAYV.

Conclusions
To the best of our knowledge, this is the first report on RAYV for refractory BNC. In our case series RAYV was successful in all patients during short follow up. At the same time, no intraoperative or major postoperative complications were observed.

Funding: none