If you are preparing for robotic prostate surgery, you may be wondering what happens to the part of your bladder that sits next to the prostate and whether it could affect your urinary control afterwards. This area is called the bladder neck, and it needs to be carefully separated from the prostate during the operation.
Once the prostate is removed, your surgeon reconnects the bladder neck to the remaining urethra. Where it is safe to do so, healthy bladder-neck tissue may be preserved because this can support earlier continence recovery, although removing the cancer safely always comes first.
What Is the Bladder Neck?
Your bladder neck is the lower part of your bladder where urine passes into your urethra. Before surgery, your urethra runs through your prostate, so your bladder neck and prostate are closely connected.
Your bladder neck contributes to urine control, but it is only one part of your continence system. Your external urethral sphincter plays a major role after surgery, so preserving the bladder neck may support recovery but cannot guarantee continence.
Where Is the Bladder Neck in Relation to the Prostate?
Your bladder neck sits just above your prostate, while your urethra runs through the prostate. During robotic prostate surgery, your surgeon carefully separates the prostate from the bladder and urethra.
Your anatomy can make this area easier or harder to identify, especially if your prostate is enlarged or you have had previous procedures. Your surgeon uses careful dissection and robotic magnification to protect nearby structures while removing the prostate.
What Happens to the Bladder Neck When the Prostate Is Removed?
During robotic prostate surgery, your surgeon carefully separates your bladder neck from the prostate before removing the gland. This leaves a temporary gap between your bladder and the remaining urethra.
Your surgeon then joins your bladder neck to the remaining urethra with stitches, creating a new urinary connection called a vesicourethral anastomosis. This allows urine to pass from your bladder through your urethra after the connection has healed.
Is the Bladder Neck Removed During Robotic Prostate Surgery?
The bladder neck is separated from the prostate during robotic prostate surgery, and your surgeon may preserve healthy bladder-neck tissue where this is technically and oncologically appropriate.
The amount preserved depends on your anatomy and where your cancer is located. Your surgeon may need to remove or open more tissue if cancer is close to the prostate base, as completely removing the cancer remains the priority.
What Is Bladder-Neck Preservation?
Bladder-neck preservation means keeping as much healthy bladder-neck tissue as safely possible during surgery. Your surgeon will only do this when it does not compromise the safe removal of your cancer.
- Preserving Healthy Tissue: Your surgeon carefully separates the prostate while keeping suitable bladder-neck tissue intact where possible.
- Supporting Urinary Control: Preserving the bladder neck may help support earlier recovery of urinary continence after surgery.
- Supporting Reconstruction: Preserving suitable bladder-neck tissue may reduce the amount of reconstruction needed when the bladder is joined to the remaining urethra.
- Cancer Safety Comes First: Your surgeon may remove more bladder-neck tissue if your cancer location or anatomy makes preservation unsuitable.
Bladder-neck preservation may support your recovery, but it cannot guarantee that you will avoid urinary leakage. Your continence also depends on your sphincter, urethral length, pelvic floor and other individual factors.
Can Every Patient Have Bladder-Neck Preservation?
No. Your surgeon may not be able to preserve your bladder neck if your cancer is close to the prostate base or your anatomy makes preservation difficult.
Your surgeon will prioritise removing your cancer safely while preserving healthy tissue where possible. Even if more bladder-neck tissue needs to be removed, it does not automatically mean you will have poor urinary control.
What Is Bladder-Neck Reconstruction?
Bladder-neck reconstruction means your surgeon reshapes the bladder opening after prostate removal so it can be joined securely to your remaining urethra. Your own bladder tissue is used, so no artificial bladder neck is placed inside you.
Your surgeon may need reconstruction if the bladder opening is wider than the urethra, depending on your anatomy and how the prostate was removed. Once the reconstructed area has healed, urine can pass through the new bladder-to-urethra connection.
Bladder-Neck Terms You May Hear Around Prostate Surgery
| Term | What It Means |
| Bladder-neck preservation | Keeping healthy bladder-neck tissue where this is technically and oncologically appropriate |
| Bladder-neck reconstruction | Reshaping the bladder opening when needed so that it can be joined securely to the urethra |
| Vesicourethral anastomosis | The new surgical connection between the bladder and remaining urethra after the prostate is removed |
| Anastomotic leak | Leakage of urine from the new connection while it is healing |
| Vesicourethral anastomotic stenosis | Scar-related narrowing of the healed bladder-to-urethra connection |
These terms describe different parts of reconstruction and healing after radical prostatectomy. Your surgeon can explain which techniques were needed in your individual operation.
How Is the Bladder Neck Joined to the Urethra?
After your prostate is removed, your surgeon brings your bladder neck down to the remaining urethra and stitches them together. This creates a new connection called a vesicourethral anastomosis, allowing urine to pass normally from your bladder into your urethra.
Your surgeon aims to make this join secure, watertight and free from unnecessary tension. Your catheter then helps keep the passage open while the connection heals.
Why Do You Need a Catheter While the Bladder Neck Heals?
After your robotic prostate surgery, you will usually have a urinary catheter passing through your urethra into your bladder. It drains urine and supports the new bladder-to-urethra connection while it heals.
Your catheter is usually kept in for around a week, although you may need it for longer depending on your healing. Your surgeon will decide when it is safe to remove it, particularly if there are concerns about leakage.
Can the New Bladder-Neck Connection Leak?
Your new bladder-to-urethra connection can sometimes leak a small amount while it heals. Your catheter helps drain urine and reduce pressure on the join, and your surgeon may keep it in longer if healing is delayed.
A temporary leak does not necessarily mean your surgery has failed. If you develop a fever, increasing pain, or your catheter stops draining properly, contact your surgical team promptly for advice.
Evidence Note
The new bladder-to-urethra connection needs time to heal after radical prostatectomy, which is why a urinary catheter is left in place temporarily. NHS surgical information explains that the catheter drains the bladder while the reconstructed connection heals, and it may need to stay in longer if healing is delayed or there are concerns about leakage. The exact timing should therefore be decided by your surgical team rather than by a fixed number of days.
Why Is the Bladder Neck Important for Urinary Continence?
Your bladder neck helps control urine, but it is only one part of your continence system. After prostate surgery, your external urethral sphincter and pelvic floor become especially important.
Preserving your bladder neck and as much functional urethral length as safely possible may support your recovery. However, it cannot guarantee that you will be fully continent immediately after surgery.
Does Preserving the Bladder Neck Guarantee You Will Be Continent?
No. Preserving your bladder neck may support earlier urinary recovery, but it cannot guarantee that you will avoid leakage.
Your recovery also depends on your sphincter, urethral length, pelvic floor, age, prostate size and urinary function before surgery. This is why your recovery can differ from someone else’s, even after a similar operation.
How Much Difference Can Bladder-Neck Preservation Make?
Preserving your bladder neck may help you regain urinary control sooner after robotic prostate surgery. Research suggests the benefit may be most noticeable during the early months of recovery.
However, it does not guarantee a specific result for you. Your recovery depends on several factors, including your anatomy, surgical technique and other continence-related structures.
Research Insight
A 2024 systematic review and meta-analysis involving 2,351 patients compared robot-assisted radical prostatectomy with and without bladder-neck sparing. Patients who had bladder-neck sparing were more likely to be pad-free at three months, but the analysis did not find a significant difference at six months or one year. This suggests that bladder-neck preservation may mainly help earlier continence recovery rather than guaranteeing a better long-term result. The studies also varied in their surgical techniques and continence definitions, so the findings cannot predict an individual patient’s outcome.
Why Is Urethral Length Important as Well?
The external urinary sphincter surrounds the urethra below the prostate and plays a major role in controlling urine after surgery. Preserving as much healthy urethral length as safely possible may help you regain continence.
Bladder-neck preservation aims to retain suitable tissue at the upper urinary outlet, while preserving functional urethral length can help protect continence-related structures below the prostate. Your surgeon considers both, along with your anatomy and cancer location, when planning your surgery.
Does a Large Prostate or Median Lobe Affect the Bladder Neck?
A large prostate or prominent median lobe can alter the anatomy around your bladder neck and may make dissection and reconstruction more technically challenging.
Your surgeon may need to reconstruct the bladder neck before reconnecting it to your urethra. Your MRI can help show this anatomy before surgery.
Does Previous TURP Affect Bladder-Neck Surgery?
Yes. Previous TURP can cause scarring and change your normal anatomy, making bladder-neck dissection more challenging.
Your surgeon may find bladder-neck preservation more difficult and reconstruction may sometimes be needed. Tell your surgeon about any previous prostate procedures so they can plan your surgery carefully.
Can Scar Tissue Narrow the New Bladder-to-Urethra Connection?
Yes. Scar tissue can sometimes form at the new bladder-to-urethra connection, causing a narrowing known as vesicourethral anastomotic stenosis.
You may notice a weaker urine stream or difficulty emptying your bladder. If these problems persist or worsen, your clinical team can assess the cause and recommend treatment if needed.
What Should You Expect After the Catheter Is Removed?
After your catheter is removed, passing urine may feel different, and some leakage is common while your bladder and continence muscles recover.
You may leak when you cough, sneeze, stand or move around. Your first few days are not a reliable guide to your final continence, so give your recovery time and follow your clinical team’s advice on pelvic floor exercises.
UK Guidance Note
NICE advises that people considering radical prostate cancer treatment should be warned about its likely effects on urinary function. If you experience troublesome urinary symptoms after treatment, NICE recommends access to specialist continence services, which may include pelvic-floor muscle re-education, bladder retraining and other conservative treatments.
What Should You Ask Your Surgeon About the Bladder Neck?
Before surgery, ask whether your anatomy is suitable for bladder-neck preservation and whether your MRI shows anything that could make surgery more difficult. You can also ask about a large median lobe or previous prostate procedures.
After surgery, ask whether your bladder neck was preserved or reconstructed and how this may affect your recovery. Your surgeon can also explain what to expect with your catheter, urinary leakage and continence recovery.
Myth vs Fact
| Myth | Fact |
| The whole bladder neck is removed with the prostate. | Your bladder remains in place. The surgeon separates the prostate from the bladder neck and may preserve healthy bladder-neck tissue or reconstruct the opening depending on your anatomy and cancer. |
| Bladder-neck preservation guarantees that you will not leak urine. | Preservation may support earlier continence recovery in some patients, but urinary control also depends on the external sphincter, urethral length, pelvic floor, age, anatomy and other surgical factors. |
| If your bladder neck needs reconstruction, something has gone wrong during surgery. | Reconstruction is sometimes a planned and appropriate part of radical prostatectomy, particularly when the bladder opening needs reshaping before it can be joined securely to the urethra. |
| A urine leak from the new connection means the prostate operation has failed. | A temporary anastomotic leak can occur during healing and may simply mean that the catheter needs to remain in place longer. It does not by itself mean that the cancer operation has failed. |
| A weak urine stream after recovery should simply be ignored. | A persistent or worsening weak stream can sometimes indicate narrowing of the bladder-to-urethra connection and should be discussed with your urology team. |
Key Takeaways
- The bladder neck is the lower part of your bladder where urine enters the urethra, and it must be separated from the prostate during radical prostatectomy.
- After the prostate is removed, the bladder is joined to the remaining urethra to create a new connection called a vesicourethral anastomosis.
- Bladder-neck preservation may support earlier continence recovery in appropriately selected patients, but it does not guarantee continence.
- A urinary catheter temporarily protects the new connection while it heals, and it should only be removed according to your surgical team’s instructions.
- Persistent leakage, fever, a worsening weak urine stream or a catheter that stops draining should be reported to your clinical team because further assessment may be needed.
Frequently Asked Questions
1. What Happens to Your Bladder Neck During Robotic Prostate Surgery?
Your surgeon carefully separates your bladder neck from the prostate before removing the gland. The bladder neck is then joined to your remaining urethra to create a new urinary connection called a vesicourethral anastomosis.
2. Is Your Bladder Neck Removed During Robotic Prostate Surgery?
Your entire bladder neck is not usually removed. Your surgeon aims to preserve as much healthy bladder-neck tissue as safely possible, although more tissue may need to be removed if your cancer is close to the prostate base.
3. What Is Bladder-Neck Preservation?
Bladder-neck preservation means keeping as much of your natural bladder neck as safely possible during surgery. This may support earlier urinary continence recovery, although it cannot guarantee that you will be fully continent.
4. Can Every Patient Have Bladder-Neck Preservation?
No. Your surgeon may not be able to preserve your bladder neck if your cancer is close to the prostate base or your anatomy makes preservation difficult. Removing the cancer safely always remains the priority.
5. What Is Bladder-Neck Reconstruction?
Bladder-neck reconstruction involves reshaping the bladder opening so it can be securely joined to your remaining urethra. Your surgeon uses your own bladder tissue, so no artificial bladder neck is inserted.
6. How Is Your Bladder Neck Joined to the Urethra?
After your prostate is removed, your surgeon brings the bladder neck down to the remaining urethra and stitches them together. This new connection allows urine to pass from your bladder into your urethra once it has healed.
7. Why Do You Need a Catheter After Bladder-Neck Surgery?
Your catheter drains urine and supports the new bladder-to-urethra connection while it heals. It is usually kept in for around a week, although your surgeon may leave it in longer if there are concerns about healing or leakage.
8. Can the New Bladder-Neck Connection Leak?
A small amount of leakage can sometimes occur while the new connection heals. Your catheter helps reduce pressure on the join, and your surgical team may keep it in longer if healing is delayed.
9. Does Bladder-Neck Preservation Guarantee Continence?
No. Preserving your bladder neck may support urinary recovery, but your external sphincter, urethral length, pelvic floor and pre-existing urinary function also affect continence. Some leakage is common during the early recovery period.
10. Can Scar Tissue Narrow the New Bladder-to-Urethra Connection?
Yes. Scar tissue can sometimes cause the bladder-to-urethra connection to narrow after surgery, which may lead to a weaker urine stream or difficulty emptying your bladder. If these symptoms persist or worsen, your clinical team can assess the cause and recommend appropriate treatment.
Final Thoughts: Understanding Your Bladder Neck After Robotic Prostate Surgery
Your bladder neck plays an important part in the reconstruction carried out after robotic prostate surgery. Understanding whether it was preserved or reconstructed, and how this may affect your urinary recovery, can help you know what to expect as you heal.
If you are exploring robotic prostate surgery in London, our team at Prostate Clinic London would be happy to talk you through your treatment options and help you understand whether surgery may be suitable for you.
References:
- National Institute for Health and Care Excellence (NICE) (2019, updated 2021) Prostate cancer: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng131
- British Association of Urological Surgeons (BAUS) (2024) Robotic-assisted radical prostatectomy (RARP). Available at: https://www.baus.org.uk/patients/information_leaflets/180/roboticassisted_laparoscopic_removal_of_prostate_for_cancer_rarp
- Cambridge University Hospitals NHS Foundation Trust (2023) Robotic radical prostatectomy: frequently-asked questions. Available at: https://www.cuh.nhs.uk/patient-information/robotic-radical-prostatectomy-frequently-asked-questions
- Ma, X., Tang, K., Yang, C., Wu, G., Xu, N., Wang, M., Zeng, X., Hu, Z., Song, R., Yuh, B., Wang, Z. and Ye, Z. (2016) ‘Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis’, Oncotarget, 7(41), pp. 67463–67475. Available at: https://pubmed.ncbi.nlm.nih.gov/27634899
- Choi, J. et al. (2024) ‘Effects of bladder neck sparing on continence outcomes of robotic-assisted radical prostatectomy: a systemic review and metaanalysis’, Prostate International, 12(4), pp. 179–185. Available at: https://pubmed.ncbi.nlm.nih.gov/39735194
- Britton, C.J., Sharma, V., Fadel, A.E., Bearrick, E., Findlay, B.L., Frank, I., Tollefson, M.K., Karnes, R.J. and Viers, B.R. (2023) ‘Vesicourethral anastomotic stenosis following radical prostatectomy: risk factors, natural history, and treatment outcomes’, The Journal of Urology, 210(2), pp. 312–322. Available at: https://pubmed.ncbi.nlm.nih.gov/37079876
- Bajpai, R.R. et al. (2022) ‘Robot-assisted radical prostatectomy after prior transurethral resection of prostate: an analysis of perioperative, functional, pathologic, and oncologic outcomes’, Journal of Endourology, 36(8), pp. 1063-1069. Available at: https://pubmed.ncbi.nlm.nih.gov/35473411