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Comparative Study
. 2025 Jul 7;43(1):413.
doi: 10.1007/s00345-025-05808-w.

Comparison of open perineal and robot-assisted reconstruction in vesicourethral anastomotic stenosis

Metin Savun  1 , Yunus Çolakoğlu  2 , Harun Özdemir  3 , Emin Taha Keskin  3 , Ramazan Uğur  3 , Mehmet Şahin  3 , Enes Yavuz  3 , Abdulmuttalip Şimşek  2
Affiliations
Comparative Study

Comparison of open perineal and robot-assisted reconstruction in vesicourethral anastomotic stenosis

Metin Savun et al. World J Urol. .

Abstract

Purpose: This study aimed to evaluate and compare the patency outcomes and complication rates associated with open perineal versus robot-assisted vesicourethral anastomosis reconstruction techniques.

Methods: A retrospective review was conducted of patients who underwent vesicourethral anastomosis reconstruction between July 2017 and January 2024. Data collected included demographic characteristics, prior endoscopic treatment, history of radiotherapy, incontinence status, operative details, and postoperative outcomes. Patency was defined as successful passage of a 16 French cystoscope or a maximum urinary flow rate exceeding 15 mL/s. The incidence of de novo incontinence and complications was also evaluated.

Results: This study included 28 patients (open perineal vesicourethral anastomosis reconstruction, n = 18; robot-assisted vesicourethral anastomosis reconstruction, n = 10). The median age was 67 years in both groups (p = 0.524). The median operation time was comparable (120 vs. 150 min, p = 0.175); however, the robot-assisted group experienced significantly reduced blood loss and shorter hospital stay (100 vs. 200 mL, p = 0.001; and 3 vs. 4 days, p = 0.001, respectively). Patency rates were similar between groups (77.8% vs. 80.0%, p = 0.944). The rate of de novo incontinence was significantly lower in the robot-assisted group (16.6% vs. 100%, p = 0.031). Patients with a history of pelvic radiotherapy and preoperative incontinence had higher rates of patency failure (p = 0.007 and p = 0.041, respectively). Postoperative complications were comparable between the groups (p = 0.724); however, patients with patency failure experienced higher complication rates than those without (p = 0.001).

Conclusion: Open and robot-assisted vesicourethral anastomosis reconstruction techniques achieved similar patency rates. Nevertheless, the robot-assisted approach offers several advantages, including reduced blood loss, shorter hospitalization, and lower rates of de novo incontinence. A history of pelvic radiotherapy, preoperative incontinence, and postoperative complications were associated with patency failure.

Keywords: Anastomotic stricture; Posterior urethral stenosis; Radical prostatectomy; Reconstructive surgical procedures; Robotic surgical procedures.

Plain language summary

What’s the context?Vesicourethral anastomotic stenosis (VUAS) is a condition in which the connection between the bladder and the urethra narrows, making it difficult to urinate in patients undergoing prostate surgery for prostate cancer.Reconstructive surgery is required when the endoscopic treatment fails. This can be performed using an open perineal approach or a robot-assisted technique; however, it is unclear which is better.What’s new?We compared the results of open and robot-assisted reconstruction surgeries in patients treated between 2017 and 2024.We analyzed operative data, surgical success, complications, and postoperative urinary incontinence to determine which method was more effective and safe.We found that;The success and complication rates of the two methods were similar.Robot-assisted surgery had less bleeding, shorter hospital stays, and lower rates of urinary incontinence.Success failure rates were higher in patients with a history of pelvic radiotherapy, preoperative incontinence, and postoperative complications.What’s the impact?The findings will help doctors choose the best approach for VUAS, thereby improving treatment decisions and patient outcomes.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. . Ethical approval: The research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects.” Ethics committee approval was obtained from the Basaksehir Cam and Sakura City Hospital Ethics Committee (approval number: 2021 − 288).

References

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