Detailed surgical technique for endoscopic urethroplasty in the treatment of anastomotic stenosis and bladder neck contracture.

Prostate procedures, including radical prostatectomies and transurethral outlet surgeries, are commonly performed in the U.S. with complications such as vesicourethral anastomotic stenosis (VUAS) and bladder neck contracture (BNC) affecting 2-12% of patients. Traditionally, patients with VUAS or BNC have been managed through recurrent dilations or resections, though success rates vary. Steroids and mitomycin C have shown some benefit, but refractory cases may require complex abdominoperineal repairs. Robotic surgeries have improved outcomes, with success rates ranging from 75% to 100%, albeit with the associated increased risks and limitations of intra-abdominal surgeries. In 2021, our group introduced the transurethral incision with transverse mucosal realignment (TUITMR) procedure, a technique that offers a similar approach to robotic urethroplasties by incising scar tissue and advancing healthy bladder mucosa. In a study of 19 patients evaluated within 1 year of surgical correction, TUITMR demonstrated an 89% success rate after one treatment and 100% after two, importantly, with no reported de novo incontinence. This paper highlights the preoperative preparation, surgical technique and postoperative considerations involved in TUITMR overall, as well as particulars related to VUAS and BNC patient populations specifically. The surgical technique is described in detail, along with tips and pearls for each group. Ultimately, we describe a minimally invasive surgical technique that utilizes healthy mucosal tissue to offer a long-lasting, and potentially permanent, solution to bladder neck complications following prostate surgery without the need for open or robotic surgical methods.