A review of management options for vesicourethral anastomotic stenosis and the emergence of robotic reconstruction.

Vesicourethral anastomotic stenosis (VUAS), a sequela of radical prostatectomy, is among the most complex conditions managed by reconstructive urologists. As a distinct entity from bladder neck contracture, VUAS can be managed endoscopically or with reconstruction. There is a paucity of higher-level evidence and head-to-head comparisons between VUAS management options. Interpretation of existing studies is further complicated by variations in diagnostic staging of VUAS, definitions of recurrent VUAS, and criteria for post-procedural success. Multiple endoscopic approaches are available including dilation, transurethral incision, transurethral resection, intralesional injections, and endoscopic urethroplasty. Classically, reconstruction for VUAS is offered after a single failed attempt at endoscopic management. Reconstructive options include transperineal reconstruction, open abdominopelvic reconstruction, and robotic-assisted surgical techniques. In recent years, several advances in reconstruction have developed into minimally invasive techniques using multi- and single-port robotics. Early outcomes of robotic reconstructive surgery demonstrate excellent rates of treatment success and, compared to open approaches, notably lower rates of