Bladder neck contracture (BNC) is a rare but challenging complication following transurethral surgery of the prostate. The first-line treatment is typically endoscopic bladder neck incision or resection. In refractory cases, open or robotic reconstruction may be considered. In this report, we aimed to present a robot-assisted bladder neck reconstruction using the double-face technique with Y-V plasty and a mucosal graft harvested from the bladder diverticulum, combined with diverticulectomy.

An 80-year-old male patient had undergone transurethral resection of the prostate (TURP) two years earlier for benign prostatic hyperplasia. Following surgery, bladder neck contracture developed, and the patient underwent six endoscopic treatments at different intervals, along with self-dilatation therapy. Due to persistent symptoms, he was referred to our centre. No anterior urethral stricture was observed on urethrography. Urinary system ultrasonography demonstrated a bladder diverticulum measuring approximately 6 × 5 cm on the right lateral bladder wall, and a prostate volume of 11 g. Pressure-flow study findings were consistent with bladder outlet obstruction. Urethrocystoscopy showed a circumferential bladder neck contracture. A bilateral deep lateral incision was performed at the bladder neck; however, the patient’s symptoms recurred six weeks after removal of the ureteral catheter.
On the day of robotic surgery, urethrocystoscopy revealed a circumferential bladder neck contracture, and minimal dilation was performed to allow passage of the ureteroscope. After placement of a ureteral catheter into the right ureter, robotic ports were inserted. The peritoneum over the diverticulum on the right lateral bladder wall was incised, and the diverticulum wall was exposed. The diverticulum was excised at the level of its neck, and the bladder wall was repaired with a 3-0 V-Loc suture; the incised peritoneal leaf was subsequently closed. The peritoneum was then incised lateral to the medial umbilical ligaments, and the Retzius space was developed. Using the balloon of the urethral catheter as a landmark, the bladder neck was identified. The fibrotic tissues surrounding the neck were excised. A Y-shaped incision was made to reach the contracture site. Fibrotic tissue within the contracture area was excised. A mucosal graft was prepared from the excised diverticulum wall and placed on the posterior aspect of the bladder neck, where it was secured with 5-0 Vicryl sutures. Subsequently, the bladder neck, which had been incised in a Y-shape, was reconstructed in a V-shape using 3-0 Vicryl sutures. The procedure was completed with placement of a 16-Fr silicone urethral catheter and an abdominal drain.

No postoperative complications were observed. The abdominal drain was removed on postoperative day 2 due to the absence of drainage, and the patient was subsequently discharged. The urethral catheter was removed on postoperative day 21, after which the patient voided satisfactorily. At the 4-month follow-up, the patient remained asymptomatic

In patients with refractory BNC following TURP, robotic assisted bladder neck reconstruction using the double-face technique with Y-V plasty and a mucosal graft harvested from the bladder diverticulum, may represent a feasible and effective treatment option.

Continence 19S (2026) 102731
DOI: 10.1016/j.cont.2026.102731