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Bladder Neck Reconstruction

This section covers reconstruction of the bladder neck and vesicourethral anastomosis — the salvage of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy, endoscopic prostate surgery, or radiation, plus bladder-neck closure when the outlet is irreparably incompetent. The decision space splits cleanly into two cohorts — BNC after endoscopic prostate surgery, and VUAS after radical prostatectomy ± radiation — which differ in their relationship to the remaining sphincter, radiation exposure and available reconstruction. Treatment is selected by anatomy, bladder function, continence and patient goals. For reservoir-side reconstruction (augmentation cystoplasty, catheterizable channels, ileovesicostomy), see Bladder Augmentation & Catheterizable Channels.

General Principles​

  • Principles of Bladder Neck ReconstructionOpening a stenotic outlet or restoring resistance for incontinence: anatomical selection, reservoir safety, tissue quality, drainage and follow-up.
  • Bladder Neck ClosureSelected salvage for a devastated outlet, with permanent suprapubic drainage or another dependable route; approach, tissue interposition and reservoir planning.

Cohorts​

  • Bladder Neck Contracture (BNC)Decision framework and treatment database for BNC after benign prostate surgery: residual lumen, prior treatment, bladder function and reconstructive options.
  • Vesicourethral Anastomotic Stenosis (VUAS)Decision framework and treatment database for VUAS after prostatectomy, with or without radiation: endoscopic selection, reconstructive alternatives and continence counseling.