To review a robotic approach to recalcitrant bladder neck obstruction and assess success and incontinence rates.
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 French flexible cystoscope or uroflowmetry rate >15ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence.
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 mins), with a mean estimated blood loss of 85cc (range 5-200cc). Median length of stay was 1 day (range 1-5 days). 3/12 patients had recurrence of obstruction, for an 75% success rate. Additionally, 82% of patients without pre-operative incontinence were continent with a median follow up of 13.5 months (range 5-30 months). There was 1 Clavien IIIb complication of pubic osteitis and pubo-vesical fistula that required vesicopubic fistula repair with pubic bone debridement.
Robotic bladder neck reconstruction 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.
Urology. 2018 May 16 [Epub ahead of print]
Eric J Kirshenbaum, Lee C Zhao, Jeremy B Myers, Sean P Elliott, Alex J Vanni, Nima Baradaran, Bradley A Erickson, Jill C Buckley, Bryan B Voelzke, Michael A Granieri, Stephen J Summers, Benjamin N Breyer, Atreya Dash, Aaron Weinberg, Nejd F Alsikafi
Loyola University, Maywood, IL. Electronic address: ., New York University, New York, NY., University of Utah, Salt Lake City, UT., University of Minnesota, Minneapolis, MN., Lahey Hospital and Medical Center, Burlington, MA., University of California San Francisco, San Francisco, CA., University of Iowa, Iowa City, IA., UC San Diego Health System, San Diego, CA., University of Washington, Seattle, WA., Uropartners, Gurnee, IL.