Robot-assisted bladder neck reconstruction for vesicourethral anastomotic stricture complicated with vesicorectal fistula after radical prostatectomy: a case report

Vesicourethral anastomotic stricture (VUAS) combined with vesicorectal fistula (VRF) is a rare and complex complication following radical prostatectomy, presenting significant challenges for conventional therapies. While minimally invasive robotic-assisted laparoscopic surgery (RALS) has emerged as a promising approach for complex genitourinary reconstruction due to its enhanced visualization and precision, detailed reports on the concurrent robotic repair of these specific concomitant pathologies remain scarce. We present a 59-year-old male who developed progressive dysuria and fecaluria following radical prostatectomy, diagnosed with VUAS and VRF, with MRI revealing extensive retropubic necrotic tissue. He underwent successful Da Vinci robotic-assisted transabdominal surgery, which entailed debridement of necrotic tissue, two-layer closure of the fistula, abandonment of the diseased original bladder neck, and creation of a new bladder neck on the anterior bladder wall with tension-free urethral anastomosis. At one-year follow-up, the patient achieved normal voiding and urinary continence (Qmax 24.5 ml/s) without recurrence or complications. Robot-assisted transabdominal bladder neck reconstruction combined with vesicorectal fistula repair represents a feasible and effective minimally invasive treatment option for this challenging post-prostatectomy condition.