Reconstructive UrologyPatency 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
Section snippets
Materials and Methods
We utilized the TURNS database as our data source. TURNS is a multi-institutional group of fellowship-trained reconstructive urologists focused on advancements in the field of genitourinary trauma and reconstruction with a prospectively maintained database.
Patients with a BNC or VUAS resulting from endoscopic prostate surgery (transurethral resection of prostate or photoselective vaporization of the prostate) or open or robotic prostatectomy who underwent RBNR were identified. As both pelvic
Results
Between 2015 and 2017, a total of 6 institutions with a single surgeon had patients that met inclusion and exclusion criteria, for a total of 12 patients. The surgeons varied in their number of cases performed. One surgeon performed 4 cases, 3 surgeons performed 2 cases while 2 surgeons performed a single case. Table 1 includes baseline patient characteristics and preoperative variables. In our series, the etiology of 7 rBNO was an endoscopic prostate procedure, while the other 5 had an open or
Comment
RBNR is a safe alternative for the treatment of rBNO with an acceptable risk of intraoperative and postoperative complications. We found a success rate of 75%, defined by the ability to successfully pass a 17 Fr cystoscope into the bladder or uroflow rate >15 ml/sec. Compared to the expected total incontinence for the perineal approach, only 18% of patients in this series experienced >1 pad per day incontinence after reconstruction if they were continent preoperatively. RBNR is a reasonable
Conclusion
rBNO is a difficult entity to treat, with nearly total incontinence after repair via the perineal approach. Robotic bladder neck contracture repair is a viable surgical option with a high patency rates and improved incontinence rates. If future incontinence procedures are needed, their outcomes may be improved.
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Complications in urological surgery: Prostate surgery
2022, Progres en UrologieRobotic-Assisted Lower Genitourinary Tract Reconstruction
2022, Urologic Clinics of North AmericaCitation Excerpt :The aforementioned techniques are significantly easier to perform with the working space of the SP platform, which facilitates dissection and suturing under the pubic bone and allows for concurrent endoscopic or transperineal manipulation. In terms of patency and continence, the short and mid-term outcomes reported thus far are highly encouraging,23 though these patients should be counseled on the possible need for adjunct procedures to restore continence including slings or artificial urinary sphincters. Crucially, if a perineal dissection can be avoided, long-term durability and continence may be improved.
Financial Disclosure: The authors declare that they have no relevant financial interests.