Precise Robotic Y-V Plasty for Vesico-Urethral Anastomotic Stenosis: Avoiding Urinary Incontinence.

OBJECTIVE: The treatment of vesico-urethral anastomotic stenosis (VUAS) is difficult because of the high risk of urinary incontinence. Cystoscopy-guided robotic Y-V plasty is hypothesized to reduce the incidence of urinary incontinence compared to traditional Y-V plasty. The purpose of this study was to evaluate the efficacy of cystoscopy-guided robotic Y-V plasty. MATERIALS AND METHODS: All patients diagnosed with VUAS following radical prostatectomy between January 2019 and December 2024 were retrospectively reviewed. Patients with damaged external urethral sphincter or stenosis involving the external sphincter were excluded. Cystoscopy-guided robotic Y-V plasty was performed at least three months after the last failed intervention. After catheter removal, patients were scheduled for re-examination at one, six, twelve and twenty-four months. Uroflowmetry was routinely performed and cystoscopy was performed at six months after surgery. Postoperative changes in patients' erectile function, lower urinary tract symptoms, and urinary continence were followed up using Five-item International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and urinary continence grading. RESULTS: Twenty-eight patients were enrolled. All patients were followed up for 6-59 (median 30) months after surgery. The final success rate was 96.4% (27/28). Normal continence was achieved in 25 patients (92.6%). Social continence occurred in 2 (7.4%). No patients experienced clinical incontinence. The patients' postoperative IPSS scores achieved significant improvement compared with preoperative. CONCLUSION: The surgical strategy cystoscopy-guided robotic Y-V plasty is more precise, direct and efficient in protecting the external urethral sphincter. It ensures a high success rate and simultaneously reduces the occurrence of urinary incontinence.