Comparison of open perineal and robot-assisted reconstruction in vesicourethral anastomotic stenosis

This study aimed to evaluate and compare the patency outcomes and complication rates associated with open perineal versus robot-assisted vesicourethral anastomosis reconstruction techniques.

A retrospective review was conducted of patients who underwent vesicourethral anastomosis reconstruction between July 2017 and January 2024. Data collected included demographic characteristics, prior endoscopic treatment, history of radiotherapy, incontinence status, operative details, and postoperative outcomes. Patency was defined as successful passage of a 16 French cystoscope or a maximum urinary flow rate exceeding 15 mL/s. The incidence of de novo incontinence and complications was also evaluated.

This study included 28 patients (open perineal vesicourethral anastomosis reconstruction, n = 18; robot-assisted vesicourethral anastomosis reconstruction, n = 10). The median age was 67 years in both groups (p = 0.524). The median operation time was comparable (120 vs. 150 min, p = 0.175); however, the robot-assisted group experienced significantly reduced blood loss and shorter hospital stay (100 vs. 200 mL, p = 0.001; and 3 vs. 4 days, p = 0.001, respectively). Patency rates were similar between groups (77.8% vs. 80.0%, p = 0.944). The rate of de novo incontinence was significantly lower in the robot-assisted group (16.6% vs. 100%, p = 0.031). Patients with a history of pelvic radiotherapy and preoperative incontinence had higher rates of patency failure (p = 0.007 and p = 0.041, respectively). Postoperative complications were comparable between the groups (p = 0.724); however, patients with patency failure experienced higher complication rates than those without (p = 0.001).

Open and robot-assisted vesicourethral anastomosis reconstruction techniques achieved similar patency rates. Nevertheless, the robot-assisted approach offers several advantages, including reduced blood loss, shorter hospitalization, and lower rates of de novo incontinence. A history of pelvic radiotherapy, preoperative incontinence, and postoperative complications were associated with patency failure.