Robot-assisted modified Y-V plasty for bladder neck contracture: single-center comparative analysis

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BACKGROUND: Bladder neck contracture (BNC) is common complication following surgery for benign prostate hyperplasia (BPH). Bladder neck reconstruction such as Y-V plasty may be considered for treatment of refractory BNC. This study aimed to compare the outcomes of robot-assisted modified Y-V plasty (RAMYV) and traditional Y-V plasty (RAYV) for refractory. Additionally, it seeks to establish a potential predictive system for postoperative patient-reported outcomes (PROs). METHODS: We retrospectively analyzed clinical data of all patients with refractory BNC who underwent robot-assisted Y-V plasty from October 2022 and January 2024. Follow-up assessments were conducted at 1, 3 and 6 months. RESULTS: Forty-eight patients with refractory BNC were included. 20 patients underwent RAYV, while 28 patients underwent RAMYV. All patients were followed for a period of six months. All patients had patent repairs and were voiding per urethra. Significant improvements were noted in the maximum urinary flow rate (Qmax), residual urine, and IPSS scores in both groups at 1, 3, and 6 months postoperatively, compared to the preoperative state. However, no statistically significant difference was found between the two groups at 1 month postoperatively. At 3 months postoperatively, the RAMYV group exhibited superior outcomes in IPSS and USS-PROM compared to the RAYV group, with statistically significant differences. At 6 months, the RAMYV group also exhibited superior outcomes in QoL and OAB-V8 compared to the RAYV group. Age and corresponding baseline scores on various scales are important predictors of lower urinary tract symptoms (LUTSs) after surgery. Preoperative scores on scales emphasizing flow assessment, such as the IPSS and USS PROM, carry significant weight, whereas age is the most influential factor in assessing storage function. This was a retrospective study, data bias was inevitable. CONCLUSIONS: YV plasty has been identified as an effective option for treating refractory BNC. Compared to RAYV, RAMYV appears to have better efficacy for patient outcomes in our six-month follow-up. Baseline scores related to age and preoperative symptom scores may serve as potential predictive factors for postoperative outcomes.

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