A Systematic Review and Meta-analysis of Surgical Reconstruction for Bladder Neck and Vesicourethral Anastomotic Stenosis: The Case for Etiology-specific Definitions and Reporting

BACKGROUND AND OBJECTIVE: The surgical management of bladder neck stenosis (BNS) and vesicourethral anastomotic stenosis (VUAS) is often reported indiscriminately despite their distinct etiologies, precluding identification of optimal treatment strategies. This systematic review and meta-analysis synthesizes outcomes by stenosis type and surgical approach to inform clinical decision-making. METHODS: In this prospectively registered review (CRD420261283660), MEDLINE, Embase, and Scopus were searched in January 2026 for studies on the reconstructive surgical management of BNS or VUAS, excluding endoscopic treatments. Data were stratified by stenosis type and surgical approach, and pooled analyses using random-effects models were performed for studies reporting either postoperative patency or reintervention-free survival (RFS). Risk of bias was assessed using ROBINS-I. KEY FINDINGS AND LIMITATIONS: Of 8421 records screened, 33 studies including 667 patients were eligible: 15 studies (n = 277) evaluated robotic approaches, 12 (n = 221) open approaches, two studies (n = 44) reported both, and four (n = 125) laparoscopic approaches. Overall, pooled success rates were higher for BNS than for VUAS, irrespective of the surgical approach. For robotic reconstruction, patency was 92% (95% confidence interval [CI], 0.82-0.97; n = 95) for BNS compared to 75% (95% CI, 0.65-0.82; n = 96) for VUAS. Similarly, open reconstruction showed patency rates of 92% (95% CI, 0.82-0.97; n = 83) for BNS versus 80% (95% CI, 0.69-0.87; n = 85) for VUAS, with a pooled RFS of 76% (95% CI, 0.42-0.93; n = 66) for VUAS. Laparoscopic functional success ranged from 89% to 95%. Complications were generally infrequent, slightly higher for robotic BNS (36%, n = 61) than for VUAS (23%, n = 86), while reporting for open approaches was inconsistent. High heterogeneity in surgical techniques, end point definitions, and follow-up durations limits interpretability. CONCLUSIONS AND CLINICAL IMPLICATIONS: Surgical outcomes of posterior nontraumatic urethral stenosis differ by stenosis etiology and approach, with generally higher success rates for BNS compared to VUAS. These findings underscore the urgent need for standardized definitions of posterior urethral stenosis focusing on stenosis-specific characteristics and surgical treatment approaches to guide optimal surgical management.