Robotic Transvesical Bladder Neck Reconstruction

Abstract

Introduction:

Robotic-assisted laparoscopic bladder neck reconstruction is a useful option for definitive surgical management of a bladder neck contracture or vesicourethral anastomotic stenosis in patients who underwent prior robotic prostatectomy. The purpose of this video is to demonstrate a reproducible technique for robotic-assisted laparoscopic management of post-prostatectomy vesicourethral anastomotic stenosis via a transvesical approach.

Materials and Methods:

We demonstrate a step-by-step video on robotic-assisted laparoscopic bladder neck reconstruction in a 55-year-old patient who developed a vesicourethral anastomotic stenosis after prior robotic prostatectomy. This technique involves a circumferential excision of the fibrotic scar and creation of a mucosa-to-mucosa, watertight, tension-free anastomosis between the bladder neck mucosa and posterior urethra.

Results:

Intraoperatively, there was evidence of a short 5 Fr vesicourethral anastomotic stenosis. Operative time was 103 minutes and estimated blood loss was 100 milliliters. There were no intraoperative complications. There was a negative leak test after filling the bladder with 150 cc of normal saline. Length of stay was 1 day. The patient’s suprapubic catheter (placed preoperatively for urethral rest) was removed intraoperatively. The patient’s catheter was removed on postoperative day 7. There were no major (Clavien >2) postoperative complications. Postoperatively, the patient had a successful trial of void and did not experience postoperative incontinence.

Conclusions:

Robotic-assisted laparoscopic bladder neck reconstruction may be utilized for definitive management in patients with bladder neck contractures and vesicourethral anastomotic stenosis.

Author Disclosure Statement:

Matthew Lee and Connor McPartland have no competing financial interests. Daniel Eun is a paid speaker, consultant, and proctor for Intuitive Surgical, a shareholder of Melzi Corp and has received trainee support from Hitachi Medical.

Patient Consent Statement:

The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Runtime of video: 5min 0 sec.