Introduction: Bladder neck contractures (BNC) are an uncommon complication following radical prostatectomy. Occasionally, BNCs can be refractory to endoscopic approaches. We describe the effectiveness of a novel robotic-assisted laparoscopic catheterizable bladder augment in treating recalcitrant BNCs.
Materials and methods: Patients undergoing robotic-assisted radical prostatectomy (RALP) between 2004-2014 who developed a postoperative BNC were identified. We documented our experience with robotic-assisted laparoscopic catheterizable bladder augment for recalcitrant BNCs. Total operative time, robotic time, estimated surgical blood, length of hospital stay, serum creatinine, complications, and postoperative course/upper tract imaging were recorded.
Results: Thirty-six of 2002 RALP patients (1.8%) experienced a post-surgical BNC at 182 days post-surgery. Twenty-two (61.1%) underwent a single dilation and/or transurethral incision. Eleven (30.6%) required = 1 procedure. Three patients (8.3%) had recalcitrant BNCs. One patient with normal bladder capacity elected open urethroplasty. The remaining two had reduced bladder capacity, detrusor over-activity and failed multiple incisions and self-catheterization. In one patient, the stricture was complete. The other patient experienced urethral leakage requiring bladder neck closure. In both patients, a robotic approach, utilizing an ileal-cecal segment as a catheterizable augment, was performed. At 16 and 89 months follow up, both are continent, with stable renal function and normal upper tracts.
Conclusion: Robotic-assisted laparoscopic catheterizable bladder augment is a viable treatment for recurrent BNCs. This approach may be particularly well suited for patients with concurrent hyperreflexia or decreased bladder capacity.