Robot-assisted reconstruction of posterior urethral stenosis: surgical techniques, graft use, and clinical outcomes

Robot-assisted posterior bladder neck (BN) reconstruction is a key technique in complex urological surgery. The posterior BN presents unique challenges due to its narrow anatomical access and lack of surrounding spongiosum. Grafts enhance structural integrity in posterior BN reconstruction, particularly in cases of significant tissue loss, stenosis, or scarring. These challenges require precise graft placement and tissue handling, which we have outlined the best techniques within the existing literature in this review. This article provides a detailed review of robot-assisted posterior BN reconstruction, focusing on graft types, surgical techniques, and outcomes to optimize reconstruction and patient recovery. A literature search was conducted on January 30th, 2025, utilizing PubMed, Medline, Web of Science, and Embase databases. The search focused on terms related to urethral reconstruction, posterior urethral stenosis (PUS), graft types, and grafting techniques in adult populations. Articles were screened for relevance at the title, abstract, and full-text levels, with reference lists of included manuscripts also reviewed. Independent reviewers conducted the selection process. Management of PUS varies based on stenosis length, location, and severity. Robotic-assisted techniques, such as vesicourethral anastomotic reconstruction (VUAR), demonstrate high success rates for complex cases. Grafts provide durable options for substitution urethroplasty, with graft selection tailored to patient-specific factors. Buccal mucosal grafts (BMGs) remain the first choice for many urologists. Robotic systems offer enhanced precision, reduced morbidity, and shorter recovery times, making them a valuable tool in reconstructive urology. Robotic-assisted posterior urethral reconstruction offers a highly effective solution for managing PUS and restoring urinary function. Advancements in surgical techniques and tissue engineering will continue to optimize outcomes and expand treatment options. Future research should focus on long-term studies, patient-centered innovations, and standardized protocols to enhance the quality of care in reconstructive urology.