Introduction: In this video we describe our experience in bladder neck plication, robotically assisted, to achieve continence in selected patients. Methods: In the last three years we performed three robotically assisted bladder neck plication procedures: two females with persistent total incontinence following previous surgeries for ectopic ureters and epispadias and one isolated epispadias in an adolescent male. For all a laparoscopic robotically-assisted bladder neck plication was electively selected. The first two procedures were successfully conducted with Da Vinci SI, while in the third case the Da Vinci XI was used. The progressive narrowing of the proximal urethra was always confirmed with combined endoscopic view. Results: All the patients were discharged on 4th post-operative day without complications. A follow-up MCUG confirmed fully preserved spontaneous voiding without post-void residuals and renal US showed persistence of normal upper urinary tracts. Conclusions: Bladder neck plication has been described successfully as complementary technique in other procedures as robotic radical prostatectomy. Open bladder neck plication, combined with endoscopic control of the urethral lumen, has been used to reach continence in epispadiac females, too. The anatomical access to the bladder neck region is extremely difficult in open surgery especially in adolescent patients. Robotic access allows a perfect combined endoscopic-laparoscopic approach to the bladder neck area and the firefly vision mode is an extremely useful addition for the correct and precise identification of the urethral segment to be plicated. SOURCE OF Funding: none
