Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis

• Published in: Urology (Ridgewood, N.J.) N.J.), 2021-06, Vol.152, p.102-108
• Main Authors: Abramowitz, David J., Balzano, Felicia L., Ruel, Nora H., Chan, Kevin G., Warner, Jonathan N.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anastomosis, Surgical - adverse effects; Cystoscopy; Humans; Laparoscopy; Male; Middle Aged; Mucous Membrane - surgery; Prostatectomy - adverse effects; Retrospective Studies; Urethral Stricture - etiology; Urethral Stricture - surgery; Urinary Bladder - surgery; Urinary Bladder Neck Obstruction - etiology; Urinary Bladder Neck Obstruction - surgery; Urologic Surgical Procedures - methods
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.02.035

To assess efficacy and safety of a novel cystoscopic technique for definitive repair of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). A retrospective review of patients who underwent a transurethral incision with transverse mucosal realignment between July 2019 and December 2020 by a single surgeon was completed. This is novel procedure of incising a scar cystoscopically and using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect, like a YV plasty. Patients were only included if they had ≥4 months follow-up. Surgical success was defined as ability to pass a 17 French flexible cystoscope through the previously stenotic segment at 4 month follow up. Nineteen patients with a median follow-up of 6 months were included in this analysis. Etiology of posterior urethral stenosis was 53% from VUAS and 47% from BNC, with 32% of patients having prior pelvic radiation. Success was achieved in 89% of patients after 1 procedure and 100% of patients achieved success after a second procedure. There was no de novo incontinence or major complications. Transurethral incision with transverse mucosal realignment  for VUAS and BNC has a high success rate after only 1 procedure. This is the first reported series of an endoscopic Y-V plasty type repair for BNC and VUAS. Longer term follow up to ensure durability and reporting from other institutions will be needed to establish reproducibility.