Current management strategies for bladder neck stenosis and vesicourethral anastomotic stenosis

Bladder neck stenosis (BNS) and vesicourethral anastomotic stenosis (VUAS) are forms of posterior urethral narrowing, typically resulting from benign prostate surgery and radical prostatectomy, respectively. Cystoscopy confirms the diagnosis, while voiding cystourethrography and retrograde urethrogram help assess disease extent. Magnetic resonance imaging may be useful in evaluating complex or previously irradiated patients. Management should be guided by the etiology, severity, and prior interventions, and ranges from endoscopic management to complex reconstruction or diversion. Endoscopic management is the first-line treatment for non-obliterative disease, typically using dilation or direct vision internal urethrotomy. Adjunctive measures such as clean intermittent catheterization or intralesional agents like mitomycin C may improve durability. Novel strategies, including transurethral incision with transverse mucosal realignment and endoscopic grafting, show early promise. Nonetheless, recurrence rates remain high, particularly after radiation. Reconstruction is indicated for obliterative or endoscopically refractory stenoses in patients with preserved bladder function. For BNS, robotic Y-V or T-plasty offers good patency but variable continence, while buccal grafts should be preserved for recurrences. Reanastomosis remains the standard reconstructive surgery for VUAS, though less effective in irradiated patients. Perineal reanastomosis yields high patency but poor continence, while abdominal access may improve continence at a higher technical cost. This review outlines current management strategies for BNS and VUAS.