The extravesical approach has long been the preferred method for repairing a vesicourethral anastomosis rupture. In recent years, a new paradigm has emerged, and the transvesical approach is being used more frequently. However, the extravesical approach may still be preferred in certain cases, particularly for complete ruptures of the anastomosis.

We present the case of a 51-year-old patient with a history of prostate adenocarcinoma treated with radical prostatectomy without associated radiotherapy. He presents with symptoms of urinary tract. The UCRM shows a complete loss of continuity between the bladder neck and the membranous urethra.

The patient is positioned in the lithotomy position and in 23° Trendelenburg. A transperitoneal laparoscopic approach is performed. The Da Vinci robot is set up on the operating table. The Retzius space is opened until the previous junction area between the bladder neck and the urethra is reached. The urethra is identified via intraoperative fibroscopy.
 The bladder is completely dissected and detached. Once the bladder neck appears sufficiently mobile, a new anastomosis is performed using two hemi-sutures of absorbable threads. The watertightness is verified with a methylene blue test.
 The reconstruction is completed by interposing a peritoneal flap in front of the suture to reduce the risk of symphysis.

We describe a reconstruction of a complete rupture of a urethrovesical anastomosis following a prostatectomy via the extravesical approach.
The extravesical approach seems to remain a good option in these cases to allow better dissection and approximation of the edges when the substance loss is expected to be significant.