Short and Intermediate-Term Outcome of Robot-Assisted Inverted YV-Plasty for Recurrent Bladder Neck Stenosis - a...

To report the technique and preliminary results for extraperitoneal robot-assisted laparoscopic YV-plasty (RAYV) for refractory bladder neck stenosis (BNS) and vesicoureteral anastomosis stenosis (VUAS).

Included were patients with recurrent BNS and VUAS who underwent RAYV at our institution. Primary outcome was short and intermediate-term functional results measured with urinary peak flow (Qmax), post-void residual urine (PVR) as well as quality of life assessment with the international prostate symptom score (IPSS) and short form health survey (SF-8). Short- and intermediate-term follow-up periods were defined as 1-6 months and 6-24 months, respectively. Secondary, all patients were reviewed for etiology as well as perioperative data. Treatment success was defined by absence of further treatment and/or need for intermittent or permanent catheterization.

Between March 2016 and October 2020 a total of 30 patients with a median age of 70.8 (64-77) years underwent RAYV with a median follow-up of 27 months. Median operative time (skin-skin) was 131 (112-145) minutes. The transurethral indwelling catheter was removed after 10 (5 - 16) days. There were no intraoperative complications but 2 postoperative major complications Clavien-Dindo IIIa and IV, respectively. Short- and intermediate-term results revealed significant improvement of IPS score from 17 (11-24) points to 11 (6-13) points and 6 (3-9) points, respectively. Further PVR decreased from 90 (5-302) mL to 0 (0-30) mL and 0 (0-90) mL, respectively, and Qmax increased from 7.4 mL/s to 13 (8-16) mL/s and 17 (12-4) mL/s, respectively. Improvement of SF-8 did not reach significance. A total of 5/30 (16.7%) patients had a treatment failure after 24 months whereof 2 had a re-stricture.

RAVY-Plasty for recurrent bladder neck stenosis is a safe and effective procedure with good functional short- and intermediate-term outcome.