Objective: To describe a novel surgical technique for reconstruction of a case of refractory bladder neck contracture (BNC) using a robotic-assisted laparoscopic (RAL) transvesical approach for subtrigonal inlay of buccal mucosal graft. BNC is a well-described yet uncommon adverse event after BPH surgery. Endoscopic management is successful in many patients but refractory cases may require reconstructive surgery.
Materials and methods: A 70-year-old male presented with a history of prior photovaporization of the prostate 2 years prior to our initial consultation. He developed a refractory BNC that did not resolve after multiple endoscopic interventions. For definitive treatment of the BNC, he underwent RAL repair with subtrigonal inlay of buccal mucosal graft. The surgical approach is demonstrated in our video.
Results: The patient underwent RAL subtrigonal inlay of buccal mucosal graft without intraoperative complication or need to convert to an open procedure. The graft harvested for repair measured 5 × 5 × 4 cm. He was discharged home on postoperative day 2. Urethral catheter was left in place for 2 weeks and suprapubic catheter was removed 4 weeks postoperatively. Voiding cystourethrogram at time of suprapubic catheter removal demonstrated no evidence of obstruction or extravasation. Uroflow qmax improved from 2 to 27 mL/s. Postvoid residual urine volume improved from 200 to 3 mL. At last follow-up, there was no evidence of recurrence.
Conclusion: Refractory cases of BNC can be successfully managed with reconstructive surgery. In this case report, we describe a novel technique for RAL reconstruction with subtrigonal inlay of buccal mucosal graft.
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