Robotic Bladder Neck Repair

One way to treat prostate cancer is radical prostatectomy which means removal of the entire prostate gland.

Urethra

Bladder

Prostate

Rectum

Front

Back

Because the urethra runs through the middle of the prostate and is connected to it, about 1-2 inches of urethra is removed when the prostate is removed.

Urethra

Bladder

Prostate

Rectum

Front

Back

The bladder is pulled down and then the urethra and “neck” of the bladder are sewn together.

Urethra

Bladder

Rectum

Front

Back

This new connection usually works well. But about 5% of the time, a scar tissue (shown in green) can develop at the connection. This risk of developing a scar tissue can go up to 15% if a man received radiation therapy in addition to prostate removal. This scar tissue can block the flow of urine.

This scar tissue can also develop without prostate removal for prostate cancer. It can happen in men who undergo a transurethral resection of the prostate ("TURP") which is a hollowing out of the inside of the prostate using a camera. This surgery is done for men with trouble urinating due to an enlarged prostate. The TURP can result in scarring at the upper part of the prostate where it joins the bladder. Although the cause of the scar is different, the treatment described below is similar.

Urethra

Bladder

Rectum

Front

Back

Balloon dilation is usually the first choice to treat this scar tissue. When balloon dilation or cutting with a scope have not worked at keeping the scar tissue open, some men will choose to pass a catheter through the area about once a day to keep the scar open.

Surgery to remove the scar tissue is another option. This surgery can be done be either going through the perineum (the area between the scrotum and the rectum.) This approach is shown with a blue arrow. Another approach is to fix the scar tissue with a surgery through the abdomen (shown with a pink arrow). The choice of which approach to use depends on several factors and can be discussed with Dr. Elliott.

Urethra

Bladder

Rectum

Front

Back

Using a robot to aid the surgery through the abdomen, the scar tissue is cut open. We don’t remove all the scar because the rectum is very close and we don’t want to injure that. Instead, we make an opening in the front side of the scar to fix it.

Urethra

Bladder

Rectum

Front

Back

We start the cut in the normal part of the bladder and extend it down through the scar tissue until we find normal urethra at the bottom end of the cut.

Urethra

Bladder

Front

We extend the cut in the normal bladder tissue upwards in a “V” shape.

Urethra

Bladder

The tip of the “V” shape is then advanced down to the healthy tip of urethra at the bottom, bringing in healthy tissue from the bladder to rebuild the unhealthy urethra-bladder connection.

Urethra

Bladder

The “V” shaped piece of bladder is then stitched in place.