Post-prostate-treatment stenosis and bladder neck contracture: reconstructive options and continence trade-offs

PURPOSE OF REVIEW: This narrative review aims to summarize the most relevant literature published in 2024-2025 regarding the management of vesicourethral anastomotic stenosis (VUAS) and bladder neck contracture (BNC) after treatment of the prostate. RECENT FINDINGS: We identified relevant articles focusing on novel treatment options regarding the management of VUAS and BNC, emphasizing patency rates and continence trade-offs. SUMMARY: Vesicourethral anastomotic stenosis and bladder neck contracture represent distinct postoperative complications following radical prostatectomy and benign prostatic hyperplasia surgery, respectively. Endoscopic therapy continues to serve as first-line treatment, though reported success rates vary substantially across modalities. Emerging minimally invasive endoluminal techniques, such as transurethral incision with transverse mucosal realignment and drug-coated balloon dilation demonstrate promising early outcomes. For recalcitrant disease, reconstructive solutions including transperineal reanastomosis, buccal mucosal graft urethroplasty, and a growing spectrum of robot-assisted approaches offer encouraging patency rates with variable impacts on continence.