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Robot-Assisted Reconstruction of the Lower Urinary Tract

  • Geolani W. Dy
  • Nabeel A. Shakir
  • Min Suk Jun
  • Lee C. ZhaoEmail author
Chapter

Abstract

Reconstruction of the posterior urethra and bladder outlet is challenging due to poor surgical exposure. Robotic assistance allows for enhanced visualization and improved dexterity in the deep pelvis, offering an addition or alternative to traditional perineal and transabdominal approaches. Moreover, the perineal approach to posterior urethral reconstruction may require extensive urethral mobilization and bulbar artery transection. The robotic approach may allow for preservation of periurethral tissue planes and vasculature, and thus contribute towards improved outcomes if future artificial urinary sphincter placement is necessary.

We describe techniques and outcomes of robotic-assisted approaches to reconstruction of the urethra and bladder outlet. These procedures include robotic-assisted Y-V plasty for treatment of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS), and robotic-assisted posterior urethroplasty for radiation induced stenosis (RIS) and pelvic fracture associated posterior urethral injury.

Keywords

Reconstructive surgery Robot-assisted surgery Robotic surgery Urology Urethroplasty 

References

  1. 1.
    Pansadoro V, Emiliozzi P. Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology. 1999;53:784–9.PubMedGoogle Scholar
  2. 2.
    Mundy AR, Andrich DE. Posterior urethral complications of the treatment of prostate cancer. BJU Int. 2012;110:304–25.PubMedGoogle Scholar
  3. 3.
    Mohammed N, Kestin L, Ghilezan M, et al. Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;82:204–12.PubMedGoogle Scholar
  4. 4.
    Hindson BR, Millar JL, Matheson B. Urethral strictures following high-dose-rate brachytherapy for prostate cancer: analysis of risk factors. Brachytherapy. 2013;12:50–5.PubMedGoogle Scholar
  5. 5.
    Hofer MD, Zhao LC, Morey AF, et al. Outcomes after urethroplasty for radiotherapy induced bulbomembranous urethral stricture disease. J Urol. 2014;191:1307–12.PubMedGoogle Scholar
  6. 6.
    Chung PH, Esposito P, Wessells H, et al. Incidence of stress urinary incontinence after posterior urethroplasty for radiation-induced urethral strictures. Urology. 2018;114:188–92.PubMedGoogle Scholar
  7. 7.
    Hofer MD, Liu JS, Morey AF. Treatment of radiation-induced urethral strictures. Urol Clin North Am. 2017;44:87–92.PubMedGoogle Scholar
  8. 8.
    Sullivan L, Williams SG, Tai KH, et al. Urethral stricture following high dose rate brachytherapy for prostate cancer. Radiother Oncol. 2009;91:232–6.PubMedGoogle Scholar
  9. 9.
    Fuchs JS, Hofer MD, Sheth KR, et al. Improving outcomes of bulbomembranous urethroplasty for radiation-induced urethral strictures in post-urolume era. Urology. 2017;99:240–5.PubMedGoogle Scholar
  10. 10.
    Meeks JJ, Brandes SB, Morey AF, et al. Urethroplasty for radiotherapy induced bulbomembranous strictures: a multi-institutional experience. J Urol. 2011;185:1761–5.PubMedGoogle Scholar
  11. 11.
    Palmer DA, Buckley JC, Zinman LN, et al. Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap. J Urol. 2015;193:902–5.PubMedGoogle Scholar
  12. 12.
    McKibben MJ, Shakir N, Fuchs JS, et al. Erosion rates of 3.5-cm artificial urinary sphincter cuffs are similar to larger cuffs. BJU Int. 2018;123:335–41.PubMedGoogle Scholar
  13. 13.
    Mock S, Dmochowski RR, Brown ET, et al. The impact of urethral risk factors on transcorporeal artificial urinary sphincter erosion rates and device survival. J Urol. 2015;194:1692–6.PubMedGoogle Scholar
  14. 14.
    Gomez RG, Campos RA, Velarde LG. Reconstruction of pelvic fracture urethral injuries with sparing of the bulbar arteries. Urology. 2016;88:207–12.PubMedGoogle Scholar
  15. 15.
    Breyer BN, Davis CB, Cowan JE, et al. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010;106:1734–8.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Borboroglu PG, Sands JP, Roberts JL, et al. Risk factors for vesicourethral anastomotic stricture after radical prostatectomy. Urology. 2000;56:96–100.PubMedGoogle Scholar
  17. 17.
    LaBossiere JR, Cheung D, Rourke K. Endoscopic treatment of vesicourethral stenosis after radical prostatectomy: outcomes and predictors of success. J Urol. 2016;195:1495–500.PubMedGoogle Scholar
  18. 18.
    Redshaw JD, Broghammer JA, Smith TG, et al. Intralesional injection of mitomycin C at transurethral incision of bladder neck contracture may offer limited benefit: TURNS study group. J Urol. 2015;193:587–92.PubMedGoogle Scholar
  19. 19.
    Brede C, Angermeier K, Wood H. Continence outcomes after treatment of recalcitrant postprostatectomy bladder neck contracture and review of the literature. Urology. 2014;83:648–52.PubMedGoogle Scholar
  20. 20.
    Ramirez D, Zhao LC, Bagrodia A, et al. Deep lateral transurethral incisions for recurrent bladder neck contracture: promising 5-year experience using a standardized approach. Urology. 2013;82:1430–5.PubMedGoogle Scholar
  21. 21.
    Theodoros C, Katsifotis C, Stournaras P, et al. Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures. Eur Urol. 2000;38:734–41.PubMedGoogle Scholar
  22. 22.
    Anger JT, Raj GV, Delvecchio FC, et al. Anastomotic contracture and incontinence after radical prostatectomy: a graded approach to management. J Urol. 2005;173:1143–6.PubMedGoogle Scholar
  23. 23.
    Nikolavsky D, Blakely SA, Hadley DA, et al. Open reconstruction of recurrent vesicourethral anastomotic stricture after radical prostatectomy. Int Urol Nephrol. 2014;46:2147–52.PubMedGoogle Scholar
  24. 24.
    Pfalzgraf D, Beuke M, Isbarn H, et al. Open retropubic reanastomosis for highly recurrent and complex bladder neck stenosis. J Urol. 2011;186:1944–7.PubMedGoogle Scholar
  25. 25.
    Tanagho EA. Bladder neck reconstruction for total urinary incontinence: 10 years experience. J Urol. 1981;125:321–6.PubMedGoogle Scholar
  26. 26.
    McGeady JB, McAninch JW, Truesdale MD, et al. Artificial urinary sphincter placement in compromised urethras and survival: a comparison of virgin, radiated and reoperative cases. J Urol. 2014;192:1756–61.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Myers JB, Brant WO, Hotaling JN, et al. Urethral strictures and artificial urinary sphincter placement. Urol Clin North Am. 2017;44:93–103.PubMedGoogle Scholar
  28. 28.
    Vanni AJ, Zinman LN, Buckley JC. Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures. J Urol. 2011;186:156–60.PubMedGoogle Scholar
  29. 29.
    Young BW. The retropubic approach to vesical neck obstruction in children. Surg Gynecol Obstet. 1953;96:150.PubMedGoogle Scholar
  30. 30.
    Primiceri G, Castellan P, Marchioni M, et al. Bladder neck contracture after endoscopic surgery for benign prostatic obstruction: incidence, treatment, and outcomes. Curr Urol Rep. 2017;18(79):79.PubMedGoogle Scholar
  31. 31.
    Reiss CP, Rosenbaum CM, Becker A, et al. The T-plasty: a modified YV-plasty for highly recurrent bladder neck contracture after transurethral surgery for benign hyperplasia of the prostate: clinical outcome and patient satisfaction. World J Urol. 2016;34:1437–42.PubMedGoogle Scholar
  32. 32.
    Kirshenbaum EJ, Zhao LC, Myers JB, 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.PubMedGoogle Scholar
  33. 33.
    Sun JY, Granieri MA, Zhao LC. Robotics and urologic reconstructive surgery. Transl Androl Urol. 2018;7:545–57.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Musch M, Hohenhorst JL, Vogel A, et al. Robot-assisted laparoscopic Y-V plasty in 12 patients with refractory bladder neck contracture. J Robot Surg. 2018;12:139–45.PubMedGoogle Scholar
  35. 35.
    Granieri MA, Weinberg AC, Sun JY, et al. Robotic Y-V plasty for recalcitrant bladder neck contracture. Urology. 2018;117:163–5.PubMedGoogle Scholar
  36. 36.
    Simonato A, Gregori A, Lissiani A, et al. Use of Solovov-Badenoch 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.PubMedGoogle Scholar
  37. 37.
    Schuettfort VM, Dahlem R, Kluth L, 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.PubMedGoogle Scholar
  38. 38.
    Wessells H, Morey AF, McAninch JW. Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium. J Urol. 1998;160:1373–5.PubMedGoogle Scholar
  39. 39.
    Koc G, Tazeh NN, Joudi FN, et al. Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table. J Endourol. 2012;26:1026–9.PubMedGoogle Scholar
  40. 40.
    Wedmid A, Mendoza P, Sharma S, et al. Rectal injury during robot-assisted radical prostatectomy: incidence and management. J Urol. 2011;186:1928–33.PubMedGoogle Scholar
  41. 41.
    Chade DC, Eastham J, Graefen M, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol. 2012;61:961–71.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Geolani W. Dy
    • 1
  • Nabeel A. Shakir
    • 2
  • Min Suk Jun
    • 3
  • Lee C. Zhao
    • 3
    Email author
  1. 1.Department of UrologyOregon Health and Science UniversityPortlandUSA
  2. 2.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of UrologyNYU LangoneNew YorkUSA

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