BNC / VUAS Reconstruction
Bladder neck contracture (BNC) and vesicourethral anastomotic stricture (VUAS) represent a challenging subset of reconstructive problems arising most commonly after radical prostatectomy, radiation therapy, or prior bladder neck surgery. The obliterated or severely stenotic outlet requires a tailored approach based on stricture length, prior treatment history, presence of incontinence, and surgeon expertise. Options range from simple endoscopic incision with steroid injection to complex combined abdominoperineal reconstruction.
Success rates should be interpreted cautiously — definitions of success vary (patent lumen, continence, freedom from reintervention), follow-up intervals differ, and most data come from small case series.
Technique Library
Direct links to the individual technique pages:
| Technique | Approach | Success Rate | Notes |
|---|---|---|---|
| Transurethral Incision with Injection of Triamcinolone | Endoscopic | ~65% | Cold-knife or electrocautery incision (typically at 12 o'clock) combined with intralesional triamcinolone injection. First-line treatment for BNC/VUAS; may require repeated sessions. Best results for thin-membrane contractures. |
| T-plasty | Endoscopic | — | Endoscopic transverse incision of the contracture combined with a longitudinal cut, creating a T-pattern to interrupt the fibrotic ring. Allows wider lumen without open surgery. |
| Dorsal BMG | Endoscopic / Robotic | — | Buccal mucosa graft applied dorsally to the bladder neck / vesicourethral junction under direct vision or robotic assistance. Provides well-vascularized mucosal augmentation for short-segment obliteration. |
| Subtrigonal Inlay | Robotic | — | Robotic-assisted subtrigonal graft placement at the bladder neck level. Graft inlaid beneath the trigone to augment a stenotic outlet; combines oncologic access with reconstructive precision. |
| Y-V Plasty | Abdominal | ~75% | Cystotomy with Y-incision at the bladder neck advanced and closed in V-configuration to widen the outlet. Applicable robotically or open; widely used for moderate BNC with adequate proximal tissue. Reported success ~75% at intermediate follow-up. |
| Tanagho Flap | Abdominal | — | Anterior bladder wall flap tubularized to reconstruct or lengthen the bladder neck outlet. Originally described for neurogenic outlet incompetence; adapted for post-prostatectomy reconstruction. |
| Young-Dees-Leadbetter | Abdominal | — | Bladder neck tubularization using trigonal muscle strips. Classic technique for pediatric neurogenic bladder incompetence; applied in adults for severe post-prostatectomy or radiation BNC when continence reconstruction is also required. |
| Kropp Procedure | Abdominal | — | Posterior bladder wall tube created as a continent catheterizable channel to replace bladder neck outlet. Primarily a pediatric technique (myelomeningocele, bladder exstrophy); adapted in adults with obliterated outlet and neurogenic dysfunction. |
| Pippi-Salle Procedure | Abdominal | — | Anterior bladder wall flap folded to create a tube that augments bladder neck resistance. Pediatric neurogenic bladder operation; included for completeness in the reconstructive armamentarium. |
| Transperineal Reanastomosis | Perineal | — | Perineal approach to excise the strictured vesicourethral anastomosis and create a tension-free reanastomosis. Mirrors the perineal approach to PFUI repair; avoids abdominal entry and is preferred when prior abdominal surgery precludes transabdominal access. |
| Combined Abdominoperineal Approach | Combined | — | Simultaneous abdominal and perineal exposure for complex, long-segment, or recurrent VUAS. Provides maximal access for complete excision of fibrotic segment, reanastomosis, and simultaneous cystoplasty or flap interposition when needed. |