Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

doi:10.1016/j.ajur.2023.08.007

Asian Journal of Urology, 2024, 11 (3): 341-347 doi: 10.1016/j.ajur.2023.08.007

Reviews

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Tenny R. Zhang^a,Ashley Alford^b,Lee C. Zhao^b,*(

)

^aDepartment of Urology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
^bDepartment of Urology, NYU Langone Medical Center, New York, NY, USA

Abstract
Related Citation (15)

Download:

HTML

PDF (810KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically, and open repair is associated with high rates of incontinence. In recent years, there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature. However, existing studies are small, heterogeneous case series. The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.

Methods: We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men. Articles in non-English, author replies, editorials, pediatric-based studies, and reviews were excluded. Outcomes of interest were patency and incontinence rates, which were pooled when appropriate.

Results: After identifying 158 articles on initial search, we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction. All were case series published from March 2018 to March 2022 ranging from six to 32 men, with the median follow-up of 5-23 months. A total of 119 patients were included in our analysis. A variety of etiologies and surgical techniques were described. Patency rates ranged from 50% to 100%, and pooled patency was 80% (95/119). De novo incontinence rates ranged from 0% to 33%, and pooled incontinence was 17% (8/47). Our findings were limited by small sample sizes, relatively short follow-ups, and heterogeneity between studies.

Conclusion: Despite limitations, current available evidence suggests comparable patency outcomes and improved incontinence outcomes for robotic bladder neck reconstruction compared to open repair. Additional prospective studies with longer-term follow-ups are needed to confirm these findings.

Key words： Bladder neck Continence Incontinence Patency Posterior urethra Reconstructive surgery Robotic surgery Stenosis Stricture Surgical outcome

Received: 07 June 2023 Available online: 20 July 2024

Corresponding Authors: *E-mail address: lee.zhao@nyulangone.org (L.C. Zhao).

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Tenny R. Zhang
	Ashley Alford
	Lee C. Zhao

TRENDMD:

Cite this article:

Tenny R. Zhang,Ashley Alford,Lee C. Zhao. Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes[J]. Asian Journal of Urology, 2024, 11(3): 341-347.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2023.08.007 OR http://www.ajurology.com/EN/Y2024/V11/I3/341

Study flow diagram.

Study	Patient, n	Etiology (n of patients)	Type of robotic repair	Follow-up, mo	Patency, n (%); method of assessment	De novo incontinence, n/total without preexisting incontinence (%)
Musch et al. [14] (Mar 2018)	12	- BNC (9); simple prostatectomy (2); high-intensity focused of prostate (1)	- Y-V plasty	23^a	- 10 (83); International Prostate Symptom Score	Incomplete reporting
Granieri et al. [19] (Jul 2018)	7	- BNC (3); VUAS (1); XRT (3)	- Y-V plasty	8^a	- 7 (100); cystoscopy	2/7 (29) not included as unclear if de novo
Kirshenbaum et al. [20] (Aug 2018)	12	- BNC (7); VUAS (5)	- Varies and includes redo anastomosis, Y-V plasty, partial prostatectomy	14^a	- 9 (75); passage of 17 Fr cystoscope or uroflowmetry of >15 mL/s	2/11 (18)
Unterberg et al. [16] (Mar 2019)	1^b	- Not specified for 1 included patient	- Not specified for 1 included patient	7^c	- 1 (100); passage of 16 Fr cystoscope	Not reported
Lavolle et al. [22] (Nov 2019)	6	- VUAS (6), of which 3 also had XRT	- Redo anastomosis±bladder flap	19^a	- 3 (50); freedom from reintervention	3/6 (50) requiring AUS not counted as unclear if de novo
Cavallo et al. [23] (Sep 2021)	12	- XRT (10), of which 1 also had salvage prostatectomy; idiopathic (2)	- Redo anastomosis±adjunctive techniques, prostatectomy, flaps	16^a	- 10 (83); passage of 16 Fr cystoscope	4/12 (33)
Liu et al. [17] (Jan 2022)	8^d	- VUAS (7), of which 4 also had XRT; trauma (1)	- BMG urethroplasty	12^a	- 6 (75); unknown	0/8 (0)
Shakir et al. [24] (Feb 2022)	32	- VUAS (32), of which 16 also had XRT	- Varies and includes primary anastomosis or anterior bladder flap	12^a	- 24 (75); passage of 17 Fr cystoscope or uroflowmetry of >15 mL/s	2/13 (15)
Bearrick et al. [21] (Mar 2022)	20	- BNC (5); VUAS (15), of which 5 also had XRT	- Y-V plasty, redo anastomosis, bladder flap, and urethral pull-through	Varied based on etiology	- 18 (90); “functional” and “anatomic” evaluation	Incomplete reporting
Zhao et al. [25] (Mar 2022)	9	- VUAS (7), of which 4 also had XRT; XRT only (2)	- Bladder flap	5^c	- 7 (78); unknown	0/3 (0)
Pooled outcome^e	119				- 95 (80)	8/47 (17)

Summary of studies (in chronological order of publication date).

[1]	Osman NI, Mangir N, Mironska E, Chapple CR. Robotic surgery as applied to functional and reconstructive urology. Eur Urol Focus 2019; 5:322-8.
[2]	Boswell TC, Hebert KJ, Tollefson MK, Viers BR. Robotic urethral reconstruction: redefining the paradigm of posterior urethroplasty. Transl Androl Urol 2020; 9:121-31.
[3]	Kim S, Buckley JC. Robotic lower urinary tract reconstruction. Urol Clin 2021; 48:103-12.
[4]	Cindolo L, Marchioni M, Emiliani E, Francesco PDE, Primiceri G, Castellan E, et al. Bladder neck contracture after surgery for benign prostatic obstruction. Minerva Urol Nefrol 2017; 69:133-43.
[5]	Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR. Incidence of bladder neck contracture after robotic-assisted laparoscopic and open radical prostatectomy. BJU Int 2010; 106:1734-8.
[6]	Browne BM, Vanni AJ. Management of urethral stricture and bladder neck contracture following primary and salvage treatment of prostate cancer. Curr Urol Rep 2017; 18:76. https://doi.org/10.1007/s11934-017-0729-0 doi: https://doi.org/10.1007/s11934-017-0729-0 pmid: 28776126
[7]	Shakir NA, Zhao LC. Robotic-assisted genitourinary reconstruction: current state and future directions. Ther Adv Urol 2021; 13:17562872211037111. https://doi.org/10.1177/17562872211037111 doi: https://doi.org/10.1177/17562872211037111
[8]	Bearrick EN, Findlay BL, Boswell TC, Hebert KJ, Viers BR. New perspectives on the surgical treatment of posterior urethral obstruction. Curr Opin Urol 2021; 31:521-30.
[9]	Wessells H, Angermeier KW, Elliott S, Gonzalez CM, Kodama R, Peterson AC, et al. Male urethral stricture: American Urological Association guideline. J Urol 2017; 197:182-90.
[10]	Liberman D, Jarosek S, Virnig BA, Chu H, Elliott SP. The patient burden of bladder outlet obstruction after prostate cancer treatment. J Urol 2016; 195:1459-63.
[11]	Andrews JR, Hebert KJ, Boswell TC, Avant RA, Boonipatt T, Kreutz-Rodrigues L, et al. Pubectomy and urinary reconstruction provides definitive treatment of urosymphyseal fistula following prostate cancer treatment. BJU Int 2021; 128:460-7.
[12]	Zhao CC, Shakir NA, Zhao LC. The emerging role of robotics in upper and lower urinary tract reconstruction. Curr Opin Urol 2021; 31:511-5.
[13]	Xu AJ, Mishra K, Lee YS, Zhao LC. Robotic-assisted lower genitourinary tract reconstruction. Urol Clin 2022; 49:507-18.
[14]	Musch M, Hohenhorst JL, Vogel A, Loewen H, Krege S, Kroepfl D. Robot-assisted laparoscopic YeV plasty in 12 patients with refractory bladder neck contracture. J Robot Surg 2018; 12:139-45.
[15]	Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. https://doi.org/10.1136/bmj.n71 doi: https://doi.org/10.1136/bmj.n71
[16]	Unterberg SH, Patel SH, Fuller TW, Buckley JC. Robot-assisted proximal perineal urethroplasty: improving visualization and ergonomics. Urology 2019; 125:230-3.
[17]	Liu E, Shakir N, Zhao LC. Single-port robotic posterior urethroplasty using buccal mucosa grafts: technique and outcomes. Urology 2022; 159:214-21.
[18]	Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 2014; 83:S1-7. https://doi.org/10.1016/j.urology.2013.09.009 doi: https://doi.org/10.1016/j.urology.2013.09.009
[19]	Granieri MA, Weinberg AC, Sun JY, Stifelman MD, Zhao LC. Robotic YeV plasty for recalcitrant bladder neck contracture. Urology 2018; 117:163-5.
[20]	Kirshenbaum EJ, Zhao LC, Myers JB, Elliott SP, Vanni AJ, Baradaran N, et al. Patency and incontinence rates after robotic bladder neck reconstruction for vesicourethral anastomotic stenosis and recalcitrant bladder neck contractures: the Trauma and Urologic Reconstructive Network of Surgeons experience. Urology 2018; 118:227-33.
[21]	Bearrick EN, Findlay BL, Maciejko LA, Hebert KJ, Anderson KT, Viers BR. Robotic urethral reconstruction outcomes in men with posterior urethral stenosis. Urology 2022; 161:118-24.
[22]	Lavolle A, de la Taille A, Chahwan C, Champy CM, Grinholtz D, Hoznek A, et al. Extraperitoneal robot-assisted vesicourethral reconstruction to manage anastomotic stricture following radical prostatectomy. Urology 2019; 133:129-34.
[23]	Cavallo JA, Vanni AJ, Dy GW, Stair S, Shakir NA, Canes D, et al. Clinical outcomes of a combined robotic, transabdominal, and open transperineal approach for anastomotic posterior urethroplasty. J Endourol 2021; 35:1372-7.
[24]	Shakir NA, Alsikafi NF, Buesser JF, Amend G, Breyer BN, Buckley JC, et al. Durable treatment of refractory vesicourethral anastomotic stenosis via robotic-assisted reconstruction: a Trauma and Urologic Reconstructive Network of Surgeons study. Eur Urol 2022; 81:176-83.
[25]	Zhao CC, Shakir NA, Zhao LC. Robotic bladder flap posterior urethroplasty for recalcitrant bladder neck contracture and vesicourethral anastomotic stenosis. Urol Video J 2022; 13:100133. https://doi.org/10.1016/j.urolvj.2022.100133 doi: https://doi.org/10.1016/j.urolvj.2022.100133
[26]	Avallone MA, Quach A, Warncke J, Nikolavsky D, Flynn BJ. Robotic-assisted laparoscopic subtrigonal inlay of buccal mucosal graft for treatment of refractory bladder neck contracture. Urology 2019; 130:209. https://doi.org/10.1016/j.urology.2019.02.048 doi: https://doi.org/10.1016/j.urology.2019.02.048 pmid: 31063762
[27]	Wessells H, Morey AF, McAninch JW. Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium. J Urol 1998; 160:1373-5.
[28]	Simonato A, Gregori A, Lissiani A, Carmignani G. Two-stage transperineal management of posterior urethral strictures or bladder neck contractures associated with urinary incontinence after prostate surgery and endoscopic treatment failures. Eur Urol 2007; 52:1499-504.
[29]	Pfalzgraf D, Beuke M, Isbarn H, Reiss CP, Meyer-Moldenhauer WH, Dahlem R, et al. Open retropubic reanastomosis for highly recurrent and complex bladder neck stenosis. J Urol 2011; 186:1944-7.
[30]	Nikolavsky D, Blakely SA, Hadley DA, Knoll P, Windsperger AP, Terlecki RP, et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol 2014; 46:2147-52.
[31]	Schuettfort VM, Dahlem R, Kluth L, Pfalzgraf D, Rosenbaum C, Ludwig T, et al. Transperineal reanastomosis for treatment of highly recurrent anastomotic strictures after radical retropubic prostatectomy: extended follow-up. World J Urol 2017; 35:1885-90.
[32]	Simonato A, Gregori A, Lissiani A, Varca V, Carmignani G. Use of SolovoveBadenoch principle in treating severe and recurrent vesico-urethral anastomosis stricture after radical retropubic prostatectomy: technique and long-term results. BJU Int 2012; 110:E456-60. https://doi.org/10.1111/j.1464-410X.2012.11132.x doi: https://doi.org/10.1111/j.1464-410X.2012.11132.x
[33]	Wessells H, Morey A, Souter L, Vanni Alex, Rahimi L, Vanni A. Urethral stricture disease guideline amendment (2023). J Urol 2023; 210:64-71.
[34]	Obiora D, Yang H, Gor RA. Robotic assisted reconstruction for complications following urologic oncologic procedures. Transl Androl Urol 2021; 10:2272-9.
[35]	Branche B, Crocerossa F, Carbonara U, Klausner AP, Roseman JT, Hampton LJ, et al. Management of bladder neck contracture in the age of robotic prostatectomy: an evidencebased guide. Eur Urol Focus 2022; 8:297-301.