After robotic prostate surgery, you can sometimes develop scar tissue where your bladder and urethra are joined. If this narrows the passage, you may notice a weaker urine stream, straining or difficulty emptying your bladder.
This is called vesicourethral anastomotic stenosis (VUAS) and is uncommon. If treatment is needed, it can often be carried out through the urethra without a major operation, although narrowing that returns or is more complex may require reconstructive surgery.
Why Can Scar Tissue Form After Robotic Prostate Surgery?
After your robotic prostate surgery, your body naturally creates some scar tissue as the bladder and urethra heal where they are joined. In most cases, this healing happens without causing you any problems.
Sometimes, however, too much scar tissue can form and tighten the opening. This can narrow your urinary passage, so you may notice that your urine flow becomes weaker or you find it harder to pass urine.
What Is Vesicourethral Anastomotic Stenosis?
After your prostate is removed, your surgeon joins your bladder neck to the remaining urethra so urine can continue to pass from your bladder through your urethra. This new connection is called the vesicourethral anastomosis.
Sometimes, scar tissue forms around this join and makes the opening narrower. This is called vesicourethral anastomotic stenosis (VUAS), and it can make it harder for you to pass urine or empty your bladder fully.
Is Bladder Neck Contracture the Same Thing?
You may hear “bladder neck contracture” and “VUAS” used to mean the same thing, but they are technically different. After your prostate is removed, any scar narrowing at the new bladder-to-urethra connection is more accurately called vesicourethral anastomotic stenosis (VUAS).
You may still see “bladder neck contracture” in older information or hear your doctor use the term casually. If you are unsure, ask your doctor where the narrowing is located. The location matters more than the name.
Does VUAS Mean Your Prostate Cancer Has Returned?
No. VUAS is a scar-related complication at the bladder-to-urethra connection and does not by itself mean that your prostate cancer has returned. It develops because the surgical area heals with excessive narrowing.
Your cancer follow-up is assessed separately, usually through PSA monitoring after prostate surgery. If your PSA becomes detectable or starts rising, your specialist will interpret that separately from any urinary narrowing.
How Common Is Scar Narrowing After Robotic Prostate Surgery?
You can develop scar narrowing after robotic prostate surgery, but it is uncommon. Around 1% to 3% of men develop VUAS, so most men recover without this problem.
Your risk can depend on your surgery, any previous treatment and how your body heals. If you do develop narrowing, your doctor can assess it and discuss suitable treatment with you.
When Does Scar Tissue Usually Cause Problems?
You may not notice scar tissue problems straight after your robotic prostate surgery. As you heal, swelling can temporarily affect your urine flow, but true scar narrowing usually develops later as the tissue tightens.
VUAS is usually diagnosed relatively early after surgery, often within the first few months, and most cases are identified within the first year. If your urine stream was initially good but gradually becomes weaker, speak to your urology team so they can check the cause.
What Symptoms Can Scar Tissue Cause?
Scar tissue can narrow your urinary passage and gradually affect how easily you pass urine. You may notice changes in your urine flow or feel that your bladder is not emptying properly.
- Weaker Urine Stream: Your urine flow may become slower or weaker as the narrowing develops.
- Difficulty Starting: You may find it harder to start passing urine or need to strain.
- Incomplete Emptying: You may feel that some urine remains in your bladder after you have finished.
- Urinary Infections: Poor bladder emptying can sometimes increase your risk of developing urinary infections.
If your urinary symptoms are getting worse, especially after an initially good recovery, speak to your urology team. They can check whether scar tissue or another urinary problem is causing the change.
Is Difficulty Passing Urine After Surgery Always Caused by Scar Tissue?
No. If you are finding it harder to pass urine after surgery, it does not always mean you have scar tissue. Swelling, infection, medicines or changes in how your bladder works can also affect your urine flow.
Your doctor can check what is causing the problem with simple tests, such as a urine test, flow test or bladder scan. If these suggest a narrowing, further tests can confirm whether scar tissue is responsible.
What Can Increase Your Risk of Scar Narrowing?
There is no single reason why VUAS develops. Studies have linked a higher risk with factors such as diabetes, a higher body mass index (BMI), a larger prostate, previous prostate treatment and complications during healing, including an anastomotic urine leak. Smoking has also been associated with scar narrowing in some studies.
Having one of these factors does not mean you will develop VUAS, and studies do not always identify the same predictors. Your surgeon will consider your general health, previous treatment, operation and recovery together when discussing your individual risk.
How Will Your Doctor Check for Scar Tissue?
Your doctor will first ask about changes in your urine flow, such as whether your stream is weaker, you need to strain or your bladder still feels full after you pass urine. You may also have a urine test to rule out an infection.
You may then have a urine flow test and an ultrasound to check how much urine remains in your bladder. These simple checks help your urologist see whether you may have a narrowing and whether further tests are needed.
Does Every Narrowing Need Treatment?
Not necessarily. If you have only mild narrowing and can empty your bladder comfortably, your doctor may recommend monitoring it rather than treating it straight away. Your symptoms, urine flow and how much urine remains in your bladder will help guide this decision.
If the narrowing is causing significant difficulty emptying your bladder, you may need treatment or temporary drainage. Your doctor will also discuss the benefits and possible effects of treatment, including changes in urinary leakage.
Will You Need a Cystoscopy?
You may need a cystoscopy if your doctor suspects scar narrowing. During this test, your urologist gently passes a small camera through your urethra to look directly at the area and see how narrow it has become.
If the narrowing is severe or more complex, you may need additional imaging to understand it better. Your doctor will recommend these tests if they are needed.
What Does It Mean if the Narrowing Is Partial or Complete?
If the connection is narrowed but not completely closed, this is called non-obliterative VUAS, and some urine can still pass through it. If the passage has completely closed, this is called obliterative VUAS.
This difference matters when treatment is planned. Endoscopic dilation or incision may be suitable for non-obliterative narrowing, while a completely obliterated connection usually needs assessment by a specialist reconstructive urology team.
What Do Different Urinary Changes Mean After Prostate Surgery?
| What You Notice | What It Could Mean | What to Do |
| Mild changes soon after catheter removal | Temporary swelling, bladder irritation or early postoperative recovery | Follow your surgical team’s advice and mention symptoms if they persist or worsen |
| A urine stream that gradually becomes weaker | Possible narrowing of the bladder-to-urethra connection | Arrange assessment with your urology team |
| Straining or feeling that your bladder does not empty fully | Possible bladder-outlet obstruction or another urinary problem | Ask for clinical assessment, which may include flow testing and a bladder scan |
| Repeated urinary infections | Incomplete bladder emptying can sometimes contribute | Speak to your clinical team so the cause can be investigated |
| Sudden inability to pass urine with a painful, full bladder | Acute urinary retention | Seek urgent medical assessment |
Symptoms alone cannot confirm VUAS because other urinary problems can cause similar changes. Your urology team can determine whether scar narrowing is responsible.
How Is Scar Tissue Usually Treated First?
If you have a narrowing that is not completely closed, your treatment will usually start with a procedure through your urethra rather than another major operation. Your urologist may use visually controlled dilation to widen the narrowing or make a controlled endoscopic incision in the scar tissue, sometimes called direct-vision internal urethrotomy (DVIU).
These treatments are less invasive and can help improve your urine flow. You may need a catheter for a short time afterwards while the area heals.
Can Treatment Make Urinary Leakage Worse?
It can in some patients. After the narrowing is treated, you may notice more urine leakage because it may previously have been partly masking weakness in your urinary sphincter.
Your doctor will discuss this risk with you before treatment. If leakage continues after the narrowing is treated, you can discuss separate treatment options for it.
Will You Need Intermittent Self-Catheterisation After Treatment?
Not everyone needs to use a catheter themselves after VUAS treatment. In selected patients, your urology team may recommend intermittent self-catheterisation after dilation or incision to help keep the narrowed area open while it stabilises.
Whether this is appropriate depends on your type of narrowing, previous treatment and risk of recurrence. If it is recommended, your clinical team should teach you how to do it safely.
UK Guidance Note
NICE recommends that people with troublesome urinary symptoms after prostate cancer treatment have access to specialist continence services for assessment, diagnosis and conservative treatment. NICE NG131 focuses on assessment and continence support after prostate cancer treatment rather than setting out a detailed VUAS treatment pathway, so specialist urethral-stricture guidance is useful when treatment is needed.
The 2026 European Association of Urology guideline recommends visually controlled dilation or direct-vision internal urethrotomy as first-line options for non-obliterative VUAS. It also advises warning patients that treatment can cause new urinary leakage or worsen existing incontinence. Completely obliterated or repeatedly recurrent stenosis may require specialist reconstructive assessment.
Can Scar Narrowing Come Back After Treatment?
Yes. Scar narrowing can return after treatment because new scar tissue can form as the area heals and narrow the connection again.
If this happens, your doctor can discuss further treatment with you. If it keeps returning, you may need a longer-term treatment option.
Evidence Note
Endoscopic treatment can successfully reopen many vesicourethral anastomotic stenoses, but recurrence is an important consideration. A systematic review and meta-analysis published in BJU International included 40 studies involving 1,452 patients and reported an overall endoscopic success rate of about 73%, although this fell to about 63% after adjustment for publication bias. Outcomes varied considerably between studies, and previous radiotherapy was associated with poorer results. This means that some patients need repeated treatment or later reconstructive surgery.
What Happens If Endoscopic Treatment Does Not Work?
If your narrowing keeps coming back or endoscopic treatment does not work, your specialist may discuss reconstructive surgery with you. This is more likely if the scar is severe or the passage is completely closed.
Reconstructive surgery aims to create a wider, more stable urinary passage. Because these are complex procedures, your specialist will also consider your continence and previous treatments when choosing the most suitable approach for you.
Research Insight
A 2026 multi-institutional study of contemporary robotic prostatectomy found VUAS rates of around 1.5% to 1.6% after standard and hood robotic techniques. Among the patients who developed VUAS, 88% achieved resolution after a single endoscopic incision or dilation followed by a structured period of intermittent self-catheterisation. However, the study was retrospective and included only 19 VUAS cases, so these results should not be treated as a guaranteed success rate for every patient.
When Should You Contact Your Urology Team?
If your urine stream is getting weaker, you are struggling to start or empty your bladder, or you often feel urine is left behind, speak to your urology team. These symptoms do not always mean you have scar tissue, but they are worth checking.
If you suddenly cannot pass urine, especially with a painful or full bladder, seek urgent medical help. Getting checked early can help your doctor find the cause and prevent the problem from becoming more severe.
Myth vs Fact
| Myth | Fact |
| Scar tissue after prostate surgery always causes a problem. | Scar formation is part of normal healing. VUAS occurs when scar tissue narrows the bladder-to-urethra connection, and the symptoms depend partly on how tight the narrowing becomes. |
| A weak urine stream after prostate surgery always means you have VUAS. | Other problems, including infection, temporary swelling and bladder dysfunction, can also affect urine flow. Tests are needed to identify the cause. |
| Bladder-neck contracture and VUAS are exactly the same condition. | The terms have historically been used interchangeably, but VUAS more accurately describes narrowing at the new bladder-to-urethra connection after radical prostatectomy. |
| One endoscopic treatment permanently cures every VUAS. | Endoscopic treatment can be effective, but scar narrowing can recur and some patients need repeat treatment or reconstructive surgery. |
| Treating the narrowing will always improve urinary leakage. | Restoring the urinary opening can sometimes reveal or worsen stress incontinence because the stenosis may previously have masked weakness in the urinary sphincter. |
Key Takeaways
- Vesicourethral anastomotic stenosis is scar-related narrowing where the bladder and urethra were reconnected after radical prostatectomy.
- VUAS is uncommon after contemporary robotic prostatectomy, with recent studies reporting rates of roughly 1% to 3%, although estimates vary.
- A gradually weakening urine stream, straining, incomplete bladder emptying or recurrent urinary infections should be assessed rather than assumed to be part of normal recovery.
- Endoscopic dilation or incision is commonly used first for a non-obliterative stenosis, but the narrowing can recur and some patients require reconstructive treatment.
- Treatment can sometimes uncover or worsen urinary leakage, so continence should be considered when planning treatment.
- If you suddenly cannot pass urine and your bladder becomes painful and full, seek urgent medical assessment.
Frequently Asked Questions
1. Can you develop scar tissue after robotic prostate surgery?
Yes, you can develop scar tissue where your bladder and urethra are joined after robotic prostate surgery. Usually, this healing causes no problems, but too much scar tissue can narrow the opening and affect your urine flow.
2. How common is scar narrowing after robotic prostate surgery?
Scar narrowing, known as vesicourethral anastomotic stenosis (VUAS), is uncommon. Contemporary robotic prostatectomy studies report VUAS rates of roughly 1% to 3%, although estimates vary between studies and surgical techniques.
3. What symptoms can scar tissue cause after prostate surgery?
You may notice a weaker or slower urine stream, difficulty starting to pass urine, straining, or a feeling that your bladder has not emptied fully. You may also need to urinate more often or develop urinary infections.
4. When can scar tissue cause problems after robotic prostate surgery?
Scar narrowing usually develops later rather than immediately after surgery. VUAS often becomes apparent within the first few months, and most cases are identified within the first year after surgery.
5. Is difficulty passing urine after surgery always caused by scar tissue?
No. Swelling, infections, medicines and changes in how your bladder works can also affect your urine flow. Your doctor can use tests such as a urine test, urine flow test or bladder scan to identify the cause.
6. How will your doctor check for scar tissue?
Your doctor may assess your symptoms and carry out a urine test, urine flow test and ultrasound bladder scan. If scar narrowing is suspected, you may also need a cystoscopy to allow your urologist to examine the area directly.
7. Does every case of scar narrowing need treatment?
No. If your narrowing is mild and you can empty your bladder comfortably, your doctor may recommend monitoring it. More significant narrowing may require treatment or temporary drainage.
8. How is scar tissue after robotic prostate surgery treated?
Treatment commonly starts with an endoscopic procedure through your urethra, such as visually controlled dilation or incision of the narrowed area. These treatments are less invasive than major surgery, and you may need a catheter temporarily afterwards.
9. Can Scar Narrowing Come Back After Treatment?
Yes. Scar narrowing can sometimes return as the area heals and new scar tissue forms. If this happens repeatedly, your specialist may discuss further treatment or reconstructive surgery with you.
10. Can treating scar tissue make urinary leakage worse?
Yes, you may experience increased urine leakage after the narrowing is treated. This can happen because the narrowing may have been partly masking weakness in your urinary sphincter. Your doctor should discuss this possibility with you before treatment.
Final Thoughts: Understanding Scar Tissue After Robotic Prostate Surgery
Scar tissue can occasionally develop where your bladder and urethra are joined after robotic prostate surgery. While narrowing is uncommon, recognising changes such as a weaker urine stream, difficulty starting or emptying your bladder, or increasing urinary problems can help you seek assessment early.
If you are considering robotic prostate surgery in London and would like specialist advice, you can contact our team at Prostate Clinic London to discuss your treatment options and arrange a consultation tailored to your individual needs.
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
- Delchet, O., Nourredine, M., González Serrano, A., Morel-Journel, N., Carnicelli, D., Ruffion, A. and Neuville, P. (2024) ‘Post-prostatectomy anastomotic stenosis: systematic review and meta-analysis of endoscopic treatment’, BJU International, 133(3), pp. 237–245. Available at: https://pubmed.ncbi.nlm.nih.gov/37501631
- European Association of Urology (EAU) (2026) EAU Guidelines on Urethral Strictures: Disease Management in Males. Available at: https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-males
- Nabavizadeh, B., Blum, K.A., Zhong, J., Winograd, J., Li, A., Dowd, J.M., Lin, C.-F., Nguyen, A.T., Zhao, L.C., Kowalczyk, K.J. and Hu, J.C. (2026) ‘Comparative outcomes and management of vesicourethral anastomotic stenosis after contemporary standard and pelvic-fascia-sparing robotic-assisted radical prostatectomy techniques’, JU Open Plus, 4(6), article e00060. Available at: https://pubmed.ncbi.nlm.nih.gov/42369976
- 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
- Petrillo, K.J., Markel, M.J., Dabbas, M.R., Chang, M.B., Shaw, N.M. and Venkatesan, K. (2025) ‘Management of vesicourethral anastomotic stenosis’, Translational Andrology and Urology, 14(9), pp. 2725–2731. Available at: https://pubmed.ncbi.nlm.nih.gov/41132356
- Valovska, M.-T., Woodle, T. and Hagedorn, J.C. (2025) ‘Surgical management of vesicourethral anastomotic stenosis’, Investigative and Clinical Urology, 66(5), pp. 383–394. Available at: https://pubmed.ncbi.nlm.nih.gov/40897657