There is no clear consensus regarding the management of recurrent bladder neck contracture (BNC) after endoscopic treatment. The purpose of this video was to describe a robotic transvesical buccal mucosal graft urethroplasty technique for recurrent BNC after a first robotic YV plasty.

The technique is described in the video. This is a 73-year-old man who had benign prostatic hypertrophy treated with monopolar transurethral resection of the prostate (TURP) in 2007 and then had 3 endoscopic treatments (monopolar RTUP, monopolar transurethral incision of BNC, and holmium laser urethrotomy) combined with self-dilations in 2019. He had a robotic YV plasty in March 2020 for a BNC recurrence. He had an urinary tract infection in the post-operative course and had worsening of symptoms 9 months after surgery with mixed symptoms and recurrence of post-void residual at 180cc. The fibroscopy showed a anterior recurrence.

The operation was performed under general anesthesia in 23° Trendelenburg position. The  Xi robot is docked and 5 ports are placed. A transperitoneal approach is used and the bladder is wide opened longitudinally.  The edges are fixed to the abdominal wall. The contracture is incised anteriorly and the fibrosis is removed. A buccal mucosa graft is then fixed in a running fashion. The graft is fixed with fast-absorbing suture. The bladder is closed and a methylene blue test is performed.  The patient was discharged at postoperative day 1. The urethral catheter was removed at day 14. There were no postoperative complications. At 12 months, there was no recurrence of stricture and the patient had 25cc PVR.

Robotic trans-vesical buccal mucosa graft for recurrent cervical sclerosis is a feasible technique that seems provide satisfactory results as a revision procedure in patients with recurrent contracture after endoscopic treatment and YV plasty. Long-term follow-up will be necessary to evaluate functional results.

Continence 2S2 (2022) 100481
DOI: 10.1016/j.cont.2022.100481