Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience.

Published

Journal Article

OBJECTIVE:To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates. MATERIALS AND METHODS:Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence. RESULTS:Between 2015 and 2017, 12 patients were identified who met study criteria and underwent RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean estimated blood loss of 85 cc (range 5-200 cc). Median length of stay was 1 day (range 1-5 days). Three of 12 patients had recurrence of obstruction for a 75% success rate. Additionally, 82% of patients without preoperative incontinence were continent with a median follow-up of 13.5 months (range 5-30 months). There was 1 Clavien IIIb complication of osteitis pubis and pubovesical fistula that required vesicopubic fistula repair with pubic bone debridement. CONCLUSION:RBNR is a viable surgical option with high patency rates and favorable continence outcomes. This is in contrast to perineal reconstruction, which has high incontinence rates. If future incontinence procedures are needed, outcomes may be improved given lack of previous perineal dissection.

Full Text

Cited Authors

  • Kirshenbaum, EJ; Zhao, LC; Myers, JB; Elliott, SP; Vanni, AJ; Baradaran, N; Erickson, BA; Buckley, JC; Voelzke, BB; Granieri, MA; Summers, SJ; Breyer, BN; Dash, A; Weinberg, A; Alsikafi, NF

Published Date

  • August 2018

Published In

Volume / Issue

  • 118 /

Start / End Page

  • 227 - 233

PubMed ID

  • 29777787

Pubmed Central ID

  • 29777787

Electronic International Standard Serial Number (EISSN)

  • 1527-9995

International Standard Serial Number (ISSN)

  • 0090-4295

Digital Object Identifier (DOI)

  • 10.1016/j.urology.2018.05.007

Language

  • eng