[Extraperitoneal robot-assisted laparoscopic modified Y-V plasty for the treatment of refractory bladder neck...

To investigate the clinical effect of extraperitoneal robot-assisted laparoscopic modified Y-V plasty (LMYVP) in the treatment of refractory bladder neck contracture (BNC).

We retrospectively analyzed the clinical data on 10 cases of refractory BNC after transurethral resection of the prostate between September 2020 and January 2023, all with a history of recurrent urethral dilatation and at least two failures in transurethral surgical treatment of scarring. After definite diagnosis and removal of some of the scar tissues to flatten the elevated bladder neck under the cystoscope, we performed robot-assisted LMYVP using the da Vinci Si robotic system and a four-port extraperitoneal approach. The surgical procedure involved an inverted T-shaped incision in the bladder neck and urethral stricture ring, an inverted V-shaped excision of the scar area at the 3－9 o'clock position on the ventral side of the prostatic urethra, continuous full-layer suturing of the bladder neck and inverted V-shaped urethra with 3-0 barbed thread, and indwelling of an F20 silicone catheter for 2 weeks. At 3 months after surgery, we performed cystoscopic examination, measured the maximum urinary flow rate (Qmax), and obtained the IPSS and quality of life (QOL) scores of the patients.

Operations were successfully completed in all the cases. At 3 months after surgery, the patients showed significantly increased Qmax (［3.65 ± 1.27］ vs ［20.3 ± 1.77］ ml/s, P < 0.05), IPSS (5.9 ± 2.02 vs 30 ± 1.15, P < 0.05) and QOL score (1.3 ± 0.95 vs 5.2 ± 0.79, P < 0.05) compared with the baseline. Cystoscopy revealed a wide and flat bladder neck with good survival and hemodynamics of the bladder flap. All the patients met the criteria for clinical cure at a median follow-up of 13.2 months.

Extraperitoneal robot-assisted LMYVP provides a new strategy for urinary tract reconstruction in the management of refractory BNC, with the advantages of minimal invasiveness, high efficiency and high success rate.