RALP: Bladder neck reconstruction and mucosal eversion

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. 

These videos depict a classic tennis racquet bladder neck reconstruction and mucosal eversion as popularized by Patrick Walsh, MD, for open prostatectomy, but used by relatively few surgeons for robotic prostatectomy. The first video shows key steps in bladder neck reconstruction, while the second demonstrates steps in the anastomosis.

Dr. Dechet: The videos by Dr. Ellis demonstrate techniques for bladder neck reconstruction and mucosal eversion prior to performing the urethral anastomosis. Mucosal eversion is performed anteriorly with interrupted sutures and a tennis-racquet closure is used to narrow the bladder neck at the 6 o'clock position. This establishes a bladder neck that is equivalent in size to the urethra at the time of the anastomosis. This technique leads to a minimal amount of suturing required on the urethral aspect of the anastomosis, as the bladder neck does not need to be "parachuted" down with multiple sutures.

Dr. Hotaling: The techniques demonstrated in this video by Dr. Ellis-and in a related video by Christopher B. Dechet, MD-are adaptations of classical open surgical radical retropubic prostatectomy by surgeons who were trained before robot-assisted laparoscopic prostatectomy (RALP) became widely available. Their techniques add to the armamentarium of the robotic prostate surgeon and represent parts of the procedure for two-high volume surgeons with excellent outcomes.

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