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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 share the AUA 2023 escalation pattern but differ in their proximity to the external sphincter, the role of radiation, and the continence stakes at every tier. For reservoir-side reconstruction (augmentation cystoplasty, catheterizable channels, ileovesicostomy), see Bladder Augmentation & Catheterizable Channels.

General Principles​

  • Principles of Bladder Neck ReconstructionOutlet resistance, lengthening-narrowing-tightening, flap-valve design, reservoir prerequisites, tissue quality, CIC planning, and salvage closure.
  • Bladder Neck ClosureDefinitive salvage for the devastated outlet — the obstructing-PVS-to-formal-BNC continuum (AUA/SUFU 2023), retropubic / transvaginal / combined approaches, tissue interposition, and concomitant catheterizable channel.

Cohorts​

  • Bladder Neck Contracture (BNC)Master decision framework + treatment database for BNC after endoscopic prostate surgery (TURP, HoLEP, ThuLEP). Endoscopic incision → repeat endoscopic ± adjunct → open / robotic Y-V plasty.
  • Vesicourethral Anastomotic Stenosis (VUAS)Master decision framework + treatment database for VUAS after radical prostatectomy ± radiation. Endoscopic incision (holmium preferred) → repeat endoscopic ± MMC / DCB → robotic / perineal D-BMG reconstruction.