Eric J Kirshenbaum1, Lee C Zhao2, Jeremy B Myers3, Sean P Elliott4, Alex J Vanni5, Nima Baradaran6, Bradley A Erickson7, Jill C Buckley8, Bryan B Voelzke9, Michael A Granieri2, Stephen J Summers3, Benjamin N Breyer6, Atreya Dash9, Aaron Weinberg2, Nejd F Alsikafi10. 1. Department of Urology, Loyola University, Maywood, IL. Electronic address: ekirshe@lumc.edu. 2. Department of Urology, New York University, New York, NY. 3. Division of Urology, University of Utah, Salt Lake City, UT. 4. Department of Urology, University of Minnesota, Minneapolis, MN. 5. Department of Urology, Lahey Hospital and Medical Center, Burlington, MA. 6. Department of Urology, University of California San Francisco, San Francisco, CA. 7. Department of Urology, University of Iowa, Iowa City, IA. 8. Department of Urology, UC San Diego Health System, San Diego, CA. 9. Department of Urology, University of Washington, Seattle, WA. 10. Uropartners, Gurnee, IL.
Abstract
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.
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.
Authors: Behzad Abbasi; Nathan M Shaw; Jason L Lui; Kevin D Li; Architha Sudhakar; Patrick Low; Nizar Hakam; Behnam Nabavizadeh; Benjamin N Breyer Journal: World J Urol Date: 2022-08-26 Impact factor: 3.661