If you are preparing for robotic prostate surgery, you may come across the term vesicourethral anastomosis and wonder what it actually means. It is the new connection your surgeon creates between your bladder and remaining urethra after your prostate has been removed.
Although the name sounds technical, its purpose is straightforward. The connection restores the pathway for urine to leave your bladder, while a temporary catheter helps protect the area as it heals. Knowing what this connection does can also make it easier to understand what to expect during your early recovery.
What Does Vesicourethral Anastomosis Mean?
The term describes the two structures being joined: “vesico” refers to the bladder and “urethral” refers to the urethra. An anastomosis is a surgical connection between two structures. In this case, your surgeon joins the bladder neck to the remaining urethra after removing the prostate.
Once healed, this connection becomes the permanent route for urine to pass from your bladder into your urethra. Its healing is separate from continence recovery, which also depends on structures such as your external urinary sphincter and pelvic floor.
Why Do the Bladder and Urethra Need to Be Reconnected?
When your prostate is removed, the section of your urethra that passes through it is removed as well. This separates your bladder from the remaining urethra.
Your surgeon reconnects your bladder neck to the remaining urethra so urine has a continuous route out of your body. This new connection restores your urinary tract after surgery.
Where Is the Anastomosis Located?
Your vesicourethral anastomosis is deep inside your pelvis, where your prostate was previously located. Your surgeon brings your bladder neck down and joins it to the remaining urethra.
The connection sits close to your external urinary sphincter, which helps control urine. Preserving this sphincter and as much healthy urethral length as possible can support your continence recovery.
How Is a Vesicourethral Anastomosis Created?
After your prostate is removed, your surgeon aligns your bladder neck with the remaining urethra and joins them with fine stitches. Robotic instruments help your surgeon perform this precisely in the pelvis.
Different surgeons use different stitching techniques, depending on their experience and your anatomy. The aim is always to create a secure, well-aligned connection that can heal without excessive tension.
What Happens to the Bladder Neck Before the Join Is Made?
Your surgeon separates your bladder neck from the prostate and preserves as much healthy tissue as safely possible. However, cancer location, a large median lobe or previous prostate surgery may make preservation more difficult.
If the bladder opening is wider after prostate removal, your surgeon may reshape it with stitches before joining it to your urethra. The priority is always complete cancer removal and a secure connection.
Why Is Preserving the Urethra Important?
The external urinary sphincter surrounds the urethra below the prostate and plays a major role in urinary control after surgery. Preserving as much healthy functional urethral length as safely possible can therefore support your continence recovery.
Your continence recovery depends on more than the new connection. Your sphincter function, pelvic floor, anatomy and other individual factors can also affect your recovery.
What Does a Watertight Anastomosis Mean?
A watertight anastomosis means your surgeon has created a secure bladder-to-urethra connection with the aim of minimising urine leakage through the new join. Your surgeon may test the connection during surgery and add extra stitches if needed.
After surgery, your catheter helps protect the connection while your tissues heal. Even when the join looks secure during your operation, your body still needs time to strengthen it naturally.
Common Terms Used When Discussing the Vesicourethral Anastomosis
| Term | What It Means |
| Vesicourethral anastomosis | The new surgical connection between the bladder neck and remaining urethra after prostate removal |
| Bladder-neck reconstruction | Reshaping the bladder opening when needed before joining it to the urethra |
| Watertight anastomosis | A connection created with the aim of preventing significant urine leakage |
| Anastomotic leak | Urine escaping through or around the new connection during early healing |
| Cystogram | An imaging test that can be used to check for leakage before catheter removal in selected patients |
| Vesicourethral anastomotic stenosis | Scar-related narrowing of the healed bladder-to-urethra connection |
Why Must the Anastomosis Be Tension-Free?
Your surgeon needs your bladder neck and urethra to meet naturally without being pulled tightly. This helps your new connection heal properly and stay securely aligned.
Your surgeon also makes sure the join is straight, even and watertight. Once it heals, the connection becomes a permanent part of your reconstructed urinary tract, although healing and urinary continence are separate aspects of your recovery.
Why Is a Catheter Left Across the Anastomosis?
Your catheter temporarily drains urine from your bladder while your new bladder-to-urethra connection heals. This reduces pressure on the join and gives your tissues time to heal securely.
The catheter passes across the new connection while it heals and allows continuous drainage of urine from your bladder. It is temporary and is removed once your surgical team considers the connection sufficiently healed.
How Long Does the Catheter Stay In?
Your catheter usually stays in for around 7 to 10 days after robotic prostate surgery, depending on how your bladder-to-urethra connection is healing.
Your surgeon may keep it in longer if there are concerns about leakage or healing. Follow your surgical team’s advice rather than removing it early, even if you feel well.
Will You Need a Cystogram Before the Catheter Is Removed?
You will not necessarily need a cystogram before your catheter is removed. Your surgeon may recommend one if there are concerns about leakage or if your surgery involved more complex reconstruction.
Whether a cystogram is used depends on your surgeon’s protocol, your operation and whether there are concerns about leakage. Your catheter can then be removed when your team feels it is safe.
Evidence Note
Research suggests that routine cystography before catheter removal may not be necessary after every uncomplicated robot-assisted radical prostatectomy. A study of 230 patients found that most had their catheter removed on postoperative day seven, while anastomotic leakage was identified in 3.9%. Leakage was more likely in patients who had bladder-neck reconstruction or previous TURP, supporting a selective rather than universal approach to cystography.
A later review also found that different imaging methods can assess the healing connection, but concluded that further research is needed to identify which patients benefit most from imaging before catheter removal.
What Is an Anastomotic Leak?
An anastomotic leak happens when some urine escapes through your new bladder-to-urethra connection while it heals. A small leak does not necessarily mean your surgery has failed.
If you have a significant leak, your catheter may need to stay in longer to give the connection more time to heal. Contact your surgical team promptly if you develop a fever, increasing pain, your catheter stops draining properly or you feel increasingly unwell.
How Does the Anastomosis Heal?
Your stitches hold your bladder and urethra together while your body repairs the connection. As new tissue forms, the join becomes stronger and eventually no longer needs the catheter for support.
Even after your catheter is removed, your tissues may still be healing. You may notice changes in your urine flow, urgency or leakage while your bladder, sphincter and pelvic floor adjust.
Does the Anastomosis Affect Urinary Continence?
Your anastomosis restores the pathway between your bladder and urethra after prostate removal. However, your urinary control depends on several other structures as you recover.
- External Sphincter: Your external urethral sphincter plays a major role in controlling urine after surgery.
- Pelvic Floor: Your pelvic floor muscles help support your bladder control as your body recovers.
- Early Leakage: You may experience some urinary leakage after your catheter is removed, even when the connection has healed well.
- Gradual Recovery: Your continence often improves gradually as your sphincter, pelvic floor and urinary system adjust after surgery.
A well-healed anastomosis does not mean you will be fully continent straight away. Your urinary control can continue to improve gradually during your recovery.
Why Are Pelvic Floor Exercises Important After the Catheter Comes Out?
Your pelvic floor muscles work with your external urethral sphincter to help you control urine after prostate surgery. Your clinical team can advise you when to restart pelvic floor exercises safely.
These exercises do not strengthen the anastomosis itself, but they can support your continence recovery. Some leakage is common at first, so your early symptoms do not predict your final urinary control.
UK Guidance Note
NICE advises that people considering radical prostate cancer treatment should be given information about possible effects on urinary function. If urinary symptoms remain troublesome after surgery, specialist continence support should be available, including pelvic-floor muscle re-education and other conservative approaches where appropriate.
Your continence recovery should therefore be assessed separately from whether the vesicourethral anastomosis itself has healed successfully. A well-healed connection does not necessarily mean that urinary control will return immediately.
Can Scar Tissue Narrow the Anastomosis?
Yes. A small proportion of patients can develop scar tissue around the healed bladder to urethra connection, causing it to become narrower. This is called vesicourethral anastomotic stenosis (VUAS).
You may notice changes such as a weaker urine stream or difficulty emptying your bladder. It is uncommon, and if you develop it, your surgeon can assess your symptoms and discuss suitable treatment.
What Symptoms Can Anastomotic Stenosis Cause?
If your anastomosis becomes narrowed, you may notice a weaker or thinner urine stream, straining to urinate or difficulty emptying your bladder. You may also feel that urine remains in your bladder after passing urine.
If your urine flow becomes weaker after you initially recovered well, tell your urology team. These symptoms can have other causes, so your team can assess what is happening.
How Is Anastomotic Stenosis Treated?
If your specialist suspects narrowing, they may check your urine flow and use a cystoscopy to look at your bladder-to-urethra connection. If treatment is needed, your urologist may use an endoscopic procedure through the urethra to dilate, incise or resect the narrowed area.
If your narrowing keeps coming back or is more severe, you may need reconstructive surgery. Your treatment will also consider your continence, as opening the narrowing can sometimes affect urinary leakage.
Research Insight
A 2025 review of vesicourethral anastomotic stenosis found that several endoscopic treatments are available, including dilation, incision and resection, while reconstructive surgery may be considered when narrowing repeatedly returns or is more complex. The authors also highlighted that evidence directly comparing different treatments remains limited.
For you as a patient, this means that anastomotic stenosis is treatable, but the most suitable approach depends on the location and severity of the narrowing, previous treatments and your existing urinary continence.
What Should You Ask About Your Anastomosis After Surgery?
After your surgery, ask whether your bladder and urethra were joined successfully, whether your bladder neck needed reconstruction and whether the connection was watertight. You can also ask when your catheter should be removed and whether it needs to stay longer than planned.
After catheter removal, ask what urinary changes are normal and when you should contact your team. Understanding what was done and what you can expect during recovery can help you feel more prepared.
Myth vs Fact
| Myth | Fact |
| The anastomosis is an artificial tube placed inside your body. | The anastomosis is made by joining your own bladder neck to your remaining urethra with sutures. No permanent artificial tube is normally required to create the connection. |
| A watertight connection guarantees that no urine can leak after surgery. | Surgeons aim to create a watertight connection, but a small postoperative leak can still occur while the tissues are healing. |
| Everyone needs a cystogram before their catheter is removed. | Cystogram practice varies. Some centres use it routinely, while others use it selectively when there is concern about leakage or a more complex reconstruction. |
| If the anastomosis heals well, you will immediately be fully continent. | Anastomotic healing and urinary continence are different. Continence also depends on the external urinary sphincter, pelvic floor, urethral length and other individual factors. |
| A weaker urine stream after recovery should always be ignored. | Persistent or worsening reduction in urine flow can sometimes indicate vesicourethral anastomotic stenosis and should be discussed with your urology team. |
Key Takeaways
- A vesicourethral anastomosis is the new connection created between your bladder neck and remaining urethra after your prostate is removed.
- A urinary catheter temporarily drains your bladder while this new connection heals, and the timing of removal varies according to your operation and recovery.
- Not every patient needs a cystogram before catheter removal; some surgical teams use imaging selectively when there is concern about leakage.
- A well-healed anastomosis does not guarantee immediate urinary continence because the external sphincter, pelvic floor, urethral length and other individual factors also affect bladder control.
- Scar-related narrowing of the connection is called vesicourethral anastomotic stenosis and should be assessed if you develop a persistent or worsening weak urine stream or difficulty emptying your bladder.
Frequently Asked Questions
1. What Is a Vesicourethral Anastomosis After Robotic Prostate Surgery?
A vesicourethral anastomosis is the new connection your surgeon creates between your bladder neck and remaining urethra after your prostate is removed. It restores the pathway for urine to pass from your bladder through your urethra.
2. Why Do Your Bladder and Urethra Need to Be Reconnected?
When your prostate is removed, the section of urethra running through it is removed as well. Your surgeon therefore reconnects your bladder neck to the remaining urethra so urine has a clear route out of your body.
3. How Is a Vesicourethral Anastomosis Created?
Your surgeon carefully aligns your bladder neck with the remaining urethra and joins them using fine stitches. The aim is to create a secure, well-aligned and watertight connection that can heal properly.
4. What Does a Watertight Anastomosis Mean?
A watertight anastomosis means your bladder and urethra have been joined securely with the aim of minimising urine leakage through the connection. Your surgeon may test the join during surgery and add stitches if necessary.
5. Why Is a Catheter Needed After the Anastomosis?
Your catheter drains urine while the new bladder-to-urethra connection heals. It also provides continuous drainage and passes across the new connection during the early healing period.
6. How Long Does the Catheter Stay In After Robotic Prostate Surgery?
Your catheter usually stays in for around 7–10 days, although the exact timing varies depending on your healing. Your surgeon may leave it in longer if there are concerns about leakage or the strength of the connection.
7. What Is an Anastomotic Leak?
An anastomotic leak occurs when urine escapes through your healing bladder-to-urethra connection. A small leak does not necessarily mean your surgery has failed, and your catheter may simply need to remain in place for longer.
8. Does the Anastomosis Affect Your Urinary Continence?
The anastomosis restores your urinary pathway, but your external urethral sphincter and pelvic floor play a major role in continence. Some leakage is common after catheter removal and often improves gradually as your urinary control recovers.
9. Can Scar Tissue Narrow Your Anastomosis?
Yes. Scar tissue can occasionally cause the bladder-to-urethra connection to become narrower, known as vesicourethral anastomotic stenosis. A weaker urine stream, straining or difficulty emptying your bladder should be discussed with your urology team.
10. What Should You Ask Your Surgeon About Your Anastomosis?
You can ask whether your bladder and urethra were joined successfully, whether your bladder neck needed reconstruction and whether the connection was watertight. It is also useful to ask when your catheter should be removed and what urinary changes to expect afterwards.
Final Thoughts: Understanding Your Vesicourethral Anastomosis After Robotic Prostate Surgery
Your vesicourethral anastomosis is an important part of your recovery after robotic prostate surgery because it reconnects your bladder to your remaining urethra. Understanding how the connection is created, why your catheter is needed and what urinary changes to expect can help you feel more prepared during your recovery.
If you are thinking about robotic prostate surgery in London, you can contact our team at Prostate Clinic London to discuss the procedure, your treatment options and what you may expect during recovery.
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
- Würnschimmel, C., Panagl, V., Mattei, A. and Fankhauser, C.D. (2022) ‘Assessment of the anastomosis after radical prostatectomy: a review of available diagnostic methods’, Urologia Internationalis, 106(11), pp. 1091–1094. Available at: https://pubmed.ncbi.nlm.nih.gov/36220005
- Yadav, R., Bansal, S. and Gupta, N.P. (2016) ‘Selective indication for check cystogram before catheter removal following robot assisted radical prostatectomy’, Indian Journal of Urology, 32(2), pp. 120–123. Available at: https://pubmed.ncbi.nlm.nih.gov/27127354
- Shah, M., Medina, L.G., Azhar, R.A., La Riva, A., Ortega, D. and Sotelo, R. (2022) ‘Urine leak after robotic radical prostatectomy: not all urine leaks come from the anastomosis’, Journal of Robotic Surgery, 16(2), pp. 247–255. Available at: https://pubmed.ncbi.nlm.nih.gov/33895942
- Naser-Tavakolian, A. and Lee, Z. (2025) ‘A review of management options for vesicourethral anastomotic stenosis and the emergence of robotic reconstruction’, Translational Andrology and Urology, 14(8), pp. 2405–2418. Available at: https://pubmed.ncbi.nlm.nih.gov/40949428
- Mac Curtain, B.M., Sugrue, D.D., Qian, W., O’Callaghan, M. and Davis, N.F. (2024) ‘Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: a systematic review and meta-analysis’, BJU International, 133(6), pp. 646–655. Available at: https://pubmed.ncbi.nlm.nih.gov/37667431