Modified robotic V‐Y plasty for post‐radical prostatectomy vesico‐urethral anastomotic stricture: Incorporating the Joshi step
Amit Hosamani, Rohit Sanjay Deshpande, Manisha Joshi, Shalaka Rohit Deshpande, Uday Chandankhede, Pankaj Joshi, Sanjay Balwant KulkarniAbstract
Background
Bladder neck contracture is a challenging complication following radical prostatectomy. While endoscopic management is the first line of treatment, recalcitrant cases often require surgical reconstruction. This report aimed to describe a minimally invasive technique for reconstructing post‐radical prostatectomy vesico‐urethral anastomotic strictures by combining an anterior robotic V‐Y plasty with the Joshi step.
Case Presentation
An elderly male with a history of robotic radical prostatectomy presented with a refractory fibrotic ring at the bladder neck and chronic kidney disease. He had previously failed two endoscopic electrocautery incisions, which resulted in acute kidney injury. A robotic bladder neck reconstruction was performed utilizing the da Vinci X system. The vesicourethral junction was exposed, and the scarred anastomotic site was excised. A non‐transecting mucosa‐to‐mucosa anastomosis (the Joshi step) was performed posteriorly using interrupted 5‐0 polydioxanone sutures. Anteriorly, a V‐Y plasty was completed using a continuous 3‐0 V‐Loc suture over an 18 French Foley catheter. Intraoperative testing confirmed a watertight closure with no evidence of leak. The urinary catheter was successfully removed at 1 month post‐surgery. The patient experienced no urinary leakage, and his serum creatinine stabilized at a nadir of 1.8 mg/dL. A post‐operative micturating cystourethrogram confirmed an adequate bladder neck opening.
Conclusion
The modified robotic V‐Y plasty incorporating the non‐transecting mucosa‐to‐mucosa anastomosis (Joshi step) is a valuable reconstructive technique for managing short‐segment vesico‐urethral anastomotic strictures.