Robot-assisted abdominoperineal vesicourethral reanastomosis

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Abstract

BACKGROUND: Vesicourethral anastomotic stricture is a narrowing of the urethra at the junction between the membranous urethra and the bladder neck. This complication is reported in 4.8% of patients following radical prostatectomy, with an average time to vesicourethral anastomotic stricture formation of 3.4 months. Minimally invasive treatment modalities, such as urethral dilation, transurethral resection, and bladder neck incision, are frequently ineffective. Reconstructive surgery is currently considered the treatment of choice for recurrent vesicourethral anastomotic stricture. According to various authors, success rates of vesicourethral anastomotic reconstruction using perineal, abdominal, or abdominoperineal approaches can reach up to 100%.

AIM: The work aimed to evaluate the outcomes of robot-assisted abdominoperineal vesicourethral reanastomosis in patients with recurrent vesicourethral anastomotic stricture.

METHODS: The study analyzed treatment outcomes in seven patients with recurrent vesicourethral anastomotic stricture who underwent robot-assisted abdominoperineal vesicourethral reanastomosis.

RESULTS: Six months postoperatively, there was a significant improvement in urinary outflow: Qmax increased from 1.8 [0; 3.6] at baseline to 13.4 [12.2; 14] mL/s, p = 0.0005. Furthermore, there was a marked reduction in lower urinary tract symptoms, with the total IPSS score decreasing from 23 [20.3; 25.8] to 9 [7.5; 11] (p = 0.0234), and an improvement in quality of life: QoL decreased from 6 [5; 6] to 2 [2; 2.5] (p = 0.0156). No patient experienced complications above Clavien–Dindo grade II. One (14.3%) patient developed de novo severe urinary incontinence, whereas two (28.6%) had persistent mild incontinence that existed prior to surgery. There were no additional interventions required during the postoperative period.

CONCLUSION: Robot-assisted abdominoperineal vesicourethral reanastomosis is a safe and effective technique for the management of recurrent vesicourethral anastomotic stricture. This approach may be considered for patients with preserved continence and extensive strictures. Further studies are needed to assess long-term surgical outcomes.

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About the authors

Sergey V. Popov

Clinical Hospital of St. Luke; Saint Petersburg Medico-Social Institute; Kirov Military Medical Academy

Email: doc.popov@gmail.com
ORCID iD: 0000-0003-2767-7153
SPIN-code: 3830-9539

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Igor N. Orlov

North-Western State Medical University named after I.I. Mechnikov

Email: doc.orlov@gmail.com
ORCID iD: 0000-0001-5566-9789
SPIN-code: 2116-4127

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Aleksey V. Tsoy

Clinical Hospital of St. Luke

Author for correspondence.
Email: alekseytsoy93@gmail.com
ORCID iD: 0000-0001-6169-2539
SPIN-code: 4253-9083

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Timur M. Topuzov

Clinical Hospital of St. Luke

Email: ttopuzov@gmail.com
ORCID iD: 0000-0002-5040-5546
SPIN-code: 8468-4547

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Nikita Yu. Gneev

North-Western State Medical University named after I.I. Mechnikov

Email: gneev46@gmail.com
ORCID iD: 0009-0003-9033-5161
Russian Federation, Saint Petersburg

Arina V. Kerechun

North-Western State Medical University named after I.I. Mechnikov

Email: arina.kerechun.02@gmail.com
ORCID iD: 0009-0008-8022-4552
Russian Federation, Saint Petersburg

Boris A. Neymark

Altai State Medical University; Clinical Hospital “Russian Railways-Medicine”

Email: neimark.b@mail.ru
ORCID iD: 0000-0001-8009-3777
SPIN-code: 7886-8442

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Barnaul; Barnaul

References

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  2. Britton CJ, Sharma V, Fadel AE, et al. Vesicourethral anastomotic stenosis following radical prostatectomy: Risk factors, natural history, and treatment outcomes. J Urol. 2023;210(2):312–322. doi: 10.1097/JU.0000000000003488
  3. Modig KK, Godtman RA, Bjartell A, et al. Vesicourethral anastomotic stenosis after open or robot-assisted laparoscopic retropubic prostatectomy-results from the laparoscopic prostatectomy robot open trial. Eur Urol Focus. 2021;7(2):317–324. doi: 10.1016/j.euf.2019.10.012
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  7. Shaw NM, Marhamati S, Friedman A, et al. Recurrent vesicourethral anastomotic stenosis following treatment for prostate cancer: an effective endoscopic treatment using bipolar plasma button and triamcinolone. Int Urol Nephrol. 2022;54(5):1001–1008. doi: 10.1007/s11255-022-03153-0
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Supplementary files

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2. Fig. 1. The patient is placed in the lithotomy position for perineal access, then transferred to the Trendelenburg position with the DaVinci Xi robotic system in place.

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3. Fig. 2. Robotic stage of the operation: a — access to the anastomosis area; b — mobilised bulbar urethra being guided into the small pelvis (the arrow indicates the Alice clamp); c — distal end of the bulbar urethra guided into the small pelvis; d, e, f — formation of a new anastomosis.

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4. Fig. 3. Perineal stage of the operation: a — mobilisation of the bulbar urethra; b — the bulbar urethra is cut off from the membranous part; c — using an Alice clamp, the bulbar urethra is inserted into the small pelvis.

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