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Bladder Neck Reconstruction

Bladder neck reconstruction addresses the bladder neck and vesicourethral anastomosis. It covers salvage of bladder neck contracture (BNC) after benign prostate surgery or radiotherapy with the prostate in situ, and vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy with or without radiotherapy[1], and selected bladder-neck closure for refractory stress incontinence in neurogenic lower urinary tract dysfunction, or for a devastated outlet, with dependable alternative drainage.[2] Two cohorts are distinguished: BNC after endoscopic prostate surgery, and VUAS after radical prostatectomy with or without radiation. They 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.

References​

1. Mac Curtain BM, Abbasi B, Fernandez AM, Leng L, Carlisle M, Breyer BN. "Current management strategies for bladder neck stenosis and vesicourethral anastomotic stenosis." Transl Androl Urol. 2025;14(9):2717-2724. doi:10.21037/tau-2025-305

2. Ginsberg DA, Boone TB, Cameron AP, et al. "The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up." J Urol. 2021;206(5):1106-1113. doi:10.1097/JU.0000000000002239