New perspectives on the surgical treatment of posterior urethral obstruction. Issue 5 (September 2021)

• Record Type: Journal Article
• Authors: Bearrick, Elizabeth N.; Findlay, Bridget L.; Boswell, Tim C.; Hebert, Kevin J.; Viers, Boyd R.
• Is Part Of: Current opinion in urology. Volume 31:Issue 5(2021)
• Publication Date: 2021-09
• Subjects: bladder neck contracture -- posterior urethral obstruction -- robotic bladder neck reconstruction -- vesicourethral anastomotic stenosis; Urology -- Periodicals; Review Literature -- Bibliography; Review Literature -- Periodicals; Male Urogenital Diseases -- Bibliography; Male Urogenital Diseases -- Periodicals; Female Urogenital Diseases -- Bibliography; Female Urogenital Diseases -- Periodicals; Urologic Diseases -- Bibliography; Urologic Diseases -- Periodicals; Periodicals; 616.6005
• DOI: 10.1097/MOU.0000000000000911
• Languages: English
• ISSNs: 1473-6586

Abstract

Abstract : Purpose of review: Posterior urethral obstruction (PUO) from prostate surgery for benign and malignant conditions poses a significant reconstructive challenge. Endoscopic management demonstrates only modest success and often definitive reconstructive solutions are necessary to limit morbidity and firmly establish posterior urethral continuity. This often demands a combined abdominoperineal approach, pubic bone resection, and even sacrifice of the external urinary sphincter and anterior urethral blood supply. Recently, a robotic-assisted approach has been described. Enhanced instrument dexterity, magnified visualization, and adjunctive measures to assess tissue quality may enable the reconstructive surgeon to engage posterior strictures deep within the confines of the narrow male pelvis and optimize functional outcomes. The purpose of this review is to review the literature regarding endoscopic, open, and robotic management outcomes for the treatment of PUO, and provide an updated treatment algorithm based upon location and complexity of the stricture. Recent findings: Contingent upon etiology, small case series suggest that robotic bladder neck reconstruction has durable reconstructive outcomes with acceptable rates of incontinence in carefully selected patients. Summary: Initial reports suggest that robotic bladder neck reconstruction for recalcitrant PUO may offer novel reconstructive solutions and durable function outcomes in select patients.