Abstract
INTRODUCTION: Benign prostatic hyperplasia (BPH) affects a significant proportion of aging males, often requiring surgical intervention when conservative treatments fail. CASE DESCRIPTION: This case report details the management of a 58-year-old male with severe lower urinary tract symptoms and a markedly enlarged prostate, presenting with bladder stones and persistent obstruction despite medication. The patient underwent an open simple prostatectomy but developed bladder neck contracture and recurrent urinary retention, necessitating a suprapubic cystostomy. Following this, a robotic-assisted approach was chosen to address the complex contracture. The surgical strategy involved a vertical posterior bladder incision, after guide wire was visualized a bladder stone was removed, resection of inflammatory tissue, and a novel 360-degree running suture with 3-0 thread for bladder neck reconstruction. This approach was followed by closure with a double-layer running suture using 3-0 V-Lock material. The patient showed significant improvement in urinary flow and symptom resolution postoperatively, with no residual contracture detected on follow-up imaging. DISCUSSION: This report highlights the effectiveness of the robotic-assisted technique and the innovative use of the 360-degree running suture for managing challenging bladder neck contractures, marking a novel application in surgical practice.