title: Robotic-assisted laparoscopic catheterizable bladder augment: a novel approach to treat recurrent bladder neck contracture following radical prostatectomy.
abstract: BACKGROUND
  Bladder neck contractures (BNC) are an uncommon complication following radical prostatectomy. Occasionally, BNCs can be refractory to endoscopic approaches. We describe the effectiveness of a novel robotic-assisted laparoscopic catheterizable bladder augment in treating recalcitrant BNCs.
  
  
  METHODS
  Patients undergoing robotic-assisted radical prostatectomy (RALP) between 2004-2014 who developed a postoperative BNC were identified. We documented our experience with robotic-assisted laparoscopic catheterizable bladder augment for recalcitrant BNCs. Total operative time, robotic time, estimated surgical blood, length of hospital stay, serum creatinine, complications, and postoperative course/upper tract imaging were recorded.
  
  
  RESULTS
  Thirty-six of 2002 RALP patients (1.8%) experienced a post-surgical BNC at 182 days post-surgery. Twenty-two (61.1%) underwent a single dilation and/or transurethral incision. Eleven (30.6%) required = 1 procedure. Three patients (8.3%) had recalcitrant BNCs. One patient with normal bladder capacity elected open urethroplasty. The remaining two had reduced bladder capacity, detrusor over-activity and failed multiple incisions and self-catheterization. In one patient, the stricture was complete. The other patient experienced urethral leakage requiring bladder neck closure. In both patients, a robotic approach, utilizing an ileal-cecal segment as a catheterizable augment, was performed. At 16 and 89 months follow up, both are continent, with stable renal function and normal upper tracts.
  
  
  CONCLUSIONS
  Robotic-assisted laparoscopic catheterizable bladder augment is a viable treatment for recurrent BNCs. This approach may be particularly well suited for patients with concurrent hyperreflexia or decreased bladder capacity.
authors.affiliation: Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wagner
authors.forename: Peter
authors.initials: P
authors.lastname: Haddock
mesh_terms: D016063:Blood Loss, Surgical; D002432:Cecum / Q000637:transplantation; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D006801:Humans; D007082:Ileum / Q000637:transplantation; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011468:Prostatectomy / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001743:Urinary Bladder / Q000601:surgery*; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology / Q000601:surgery*; D014546:Urinary Catheterization
chemical_list: D003404:Creatinine