Skip to main content

Y-V Plasty

Y-V plasty is a family of advancement repairs in which a Y-shaped incision and advancement of a triangular tissue segment change the closure configuration toward a V. Running cutaneous Y-V scar release, bladder-wall Y-V reconstruction, Foley pyeloplasty and meatal Y-V repair share a geometric name but differ in tissue planes, vascular pedicles and selection criteria; no single no-undermining or low-necrosis rule covers them all.[1][2] In GU practice, Y-V designs have been reported for refractory bladder neck contracture (BNC) or vesicourethral anastomotic stenosis (VUAS), ureteropelvic-junction obstruction and post-hypospadias meatal stenosis.

The procedure-specific technique pages are listed under See Also.

Geometric Principles​

The fundamental geometry of Y-V plasty involves three elements:

  1. The Y-shaped incision. Two limbs diverge from a central point (the upper arms of the Y) and a single stem extends distally. The tissue between the upper limbs forms a triangular (V-shaped) flap.
  2. Advancement mechanism. The triangular flap slides forward along its substratum (without being lifted off its base) into the stem of the Y. This converts the Y into a V configuration, lengthening the tissue along the axis of the original stem.
  3. Pedicle and tissue quality. The original running cutaneous Y-V design advances tissue on its local base, but operative dissection and vascular risk differ for bladder wall, renal pelvis and meatus. Perfusion cannot be assumed in scarred or irradiated tissue.[1][3]

Y-V advancement geometry: Generic cutaneous advancement, conceptual plan view

A triangular tongue of tissue slides along the stem of a Y incision so the closure forms a V, redistributing local tissue. Advancement does not imply a universal length gain. The original running Y-V burn-scar technique is distinct from other GU Y-V and cutaneous V-Y variants. (Original WARWIKI schematic)

Mathematical analysis​

For a multiple Y-V plasty applied to a rectangular scar of length l and width a, the gain in length simplifies to:

Gain  =  (l × x) / a

where x is the advancement distance of the triangular flap in that modeled multiple cutaneous Y-V design.[4]

Y-V vs. V-Y plasty — directional distinction​

The names describe opposite incision-to-closure directions, but the clinical operations are not interchangeable:

OperationIncision → closureEffectTypical use
Y-V plastyY → VAdvances tissue across a contracted segmentSelected cutaneous contractures and luminal stenoses
V-Y plastyV → YAdvances a flap into a neighboring defectSelected cutaneous wounds (vulvar, perineal or scrotal)
[5][6]

Applications in Plastic Surgery​

Burn-scar contracture release is the classic indication. The "running Y-V plasty" technique uses multiple parallel Y-shaped incisions across a linear scar cord; each triangular flap slides into its respective stem, collectively lengthening the entire contracture without undermining.[1][3]

Advantages:

  • Limited donor dissection in the reported running cutaneous design[3]
  • Applicability to cord-like or linear contractures of the axilla, extremities, and trunk[2][7]
  • The opposite running Y-V plasty variant uses Y-V flaps from both sides of a broad contracture band, particularly useful for axillary contractures[7]
  • The procedure can be repeated when the initial release is insufficient[7]

Other plastic-surgery applications include release of nostril stenosis, congenital soft-tissue shortening, nasal-tip / alar resurfacing, and supplemental release after Z-plasty.[2][8]

Applications in Urology​

The same geometric principle (advancing healthy tissue into a stenotic or contracted segment) has been adapted across the GU tract.

1. Refractory Bladder Neck Contracture (BNC) and VUAS​

For treatment-refractory BNC after surgery for benign prostatic obstruction, the 2026 EAU guideline weakly recommends Y-V or T-plasty reconstruction and strongly recommends counseling about de novo incontinence.[24] The 2023 AUA amendment conditionally recommends that surgeons may perform robotic or open reconstruction for recalcitrant BNC or post-prostatectomy VUAS .[26] Bladder-wall Y-V reconstruction has also been described for selected VUAS after endoscopic management.[10] The two-or-more failed-treatment threshold was an enrollment criterion in one 18-patient BNC cohort.[9][10]

Technique​

A Y-shaped incision is made on the anterior bladder wall, with the stem extending through the contracture into healthy urethra. The V-shaped bladder flap is advanced distally to widen the bladder neck, and fibrotic tissue is excised.[11][12]

ApproachNotes
Open Y-V plastyMidline lower-abdominal exposure; V-shaped anterior bladder incision continued from its apex through the contracture into healthy urethra to form the Y; fibrotic tissue excised; posterior urethrovesical anastomosis and flap-to-urethra sutures[11]
Extraperitoneal laparoscopic modified Y-VBarbed-suture approach reported[12]
Robotic Y-V plasty (RAYV / RYVBNR)Robotic approach (extraperitoneal in Abo Youssef's series); Firefly near-infrared imaging of cystoscope light was used to localize the contracture in Granieri's series; median operative time was 240 min in Granieri's seven patients and 131 min in Abo Youssef's 30 patients[10][13]
Endoscopic Y-V-like mucosal realignmentA distinct transurethral technique, not a bladder-wall Y-V flap. The initial mixed BNC/VUAS series reported 89% cystoscopic patency after one procedure and 100% after a second in 19 patients at median six-month follow-up.[14] A later retrospective cohort of 92 men with BNC after benign-prostate surgery reported 93.5% single-procedure cystoscopic patency, 83.7% freedom from reintervention and 96.7% final patency after up to two procedures at median 15.9 months.[25]

Outcomes​

OutcomeRange across series
Open Y-V plasty success100% freedom from further instrumentation in one 18-patient post-transurethral-prostatectomy BNC series (mean follow-up 14.8 mo)[9]. A 2025 series of five patients after transurethral prostate surgery reported cystoscope passage without resistance and no additional procedure in all at median 13 months; three used one to two pads daily postoperatively.[11]
Robotic Y-V plasty success100% at median 8 mo in 7 patients (Granieri)[10]; 25/30 (83.3%) met a composite endpoint of no further treatment or catheterization at 24 mo in a mixed BNS/VUAS series (Abo Youssef RAYV); 2/30 had restricture; two major postoperative complications were reported (Clavien–Dindo IIIa and IV). IPSS improved from 17 to 6, PVR from 90 to 0 mL, and Qmax from 7.4 to 17 mL/s[13]
ContinenceDefinitions and baseline function vary.[10][13]In a separate 21-patient robotic Y-V series, de novo stress incontinence was reported in 5/6 men with VUAS and 0/15 with BNC; one affected man already had an AUS and three had concomitant AUS placement.[23]
Persistent storage symptoms61% in the same 18-patient post-transurethral-prostatectomy cohort; higher BMI and baseline IPSS predicted postoperative OAB-V8 change in its regression model[9]

2. Foley Y-V Pyeloplasty for Ureteropelvic Junction Obstruction​

The Foley Y-V pyeloplasty is a non-dismembered technique reported for selected UPJ obstruction:[15][16][17]

  • A Y-shaped incision is made with the stem crossing the stenotic UPJ and the arms extending onto the renal pelvis
  • The resulting V-flap of pelvic wall is advanced across the obstruction
  • In one prospective laparoscopic comparison enrolling 25 patients per arm and allocated by odd/even patient numbering, the authors reported composite success (pain relief plus unobstructed renography and stable or improved differential function) of 86% for Y-V versus 95% for Anderson-Hynes over about 26 months; the difference was not statistically significant.[15]
  • The anterior modification was used in 36 patients with a small or intrarenal pelvis and no dorsally crossing vessel, where dismembered pyeloplasty is technically difficult; complete success was 34/35 (97.1%) at mean 24 months[16]
  • A modification extending the cranial limbs in an elliptic fashion allows simultaneous reduction of a hydronephrotic pelvis; it was reported in three women without obstruction at 10 to 43 months[18]
  • A crossing vessel changes operative planning but is not, by itself, an absolute exclusion: crossing vessels were more common in the Y-V arm of one comparative trial, while the cited 54-patient series selected technique by vessel course and pelvic anatomy[15][19]

See Pyeloplasty for the full technique page.

3. Y-V Meatoplasty for Meatal Stenosis​

For post-hypospadias meatal stenosis, Kim and King described a dorsal glans V flap advanced after a posterior urethral incision into noninflamed tissue.[21] Sennert et al.'s later inverted-V skin-flap repair for ring meatal stenosis proceeds as follows, with each flap limb measuring 3–5 mm:[20]

  • A small inverted V-flap is elevated at the meatal tip
  • The stenotic ring is excised
  • The flap is advanced into the widened meatus, interrupting the circumferential scar line
  • A single-center retrospective 57-patient series reported symptom relief in 55/57 (96.5%) with median 4-year follow-up; six patients were followed for less than one year[20]

4. Y-V Glanuloplasty in Distal Hypospadias Repair​

Y-V glanuloplasty has been used as part of distal hypospadias repair, where a Y-shaped glans incision is converted to a V to accommodate the advanced urethra.[22]

Indications Across the GU Tract​

  • Selected refractory BNC after endoscopic treatment; one cohort enrolled patients after two previous failures
  • Selected refractory VUAS after radical prostatectomy; Y-V repair was reported in one patient after prior endoscopic treatment.[10]
  • Bladder-neck stenosis after TURP or holmium enucleation
  • Selected UPJ obstruction with anatomy suitable for Foley Y-V pyeloplasty, including small or intrarenal pelvis in reported series
  • Selected post-hypospadias meatal stenosis (Y-V meatoplasty)
  • Short meatal stenosis in trans women. For stenosis <1 cm when open reconstruction is indicated, the 2026 EAU guideline weakly recommends Y-V meatoplasty.[27]
  • Distal hypospadias as part of glanuloplasty
  • Concurrent stress incontinence requires a separate AUS assessment

Contraindications and Caveats​

  • Active infection at the operative site
  • Extensive bladder-neck calcification. May require adjunctive debridement
  • Heavily irradiated field. For redo VUA, the EAU guideline calls for adequate bladder function and absence of urethral necrosis, calcification or fistula; gracilis or peritoneal flap support may benefit selected irradiated anastomoses.[24] See also omental flap.
  • Crossing vessels at the UPJ. Assess vessel position and whether transposition or dismemberment is needed[15][19]
  • Patient expectation management. 61% persistent storage symptoms in one small BNC cohort despite 100% success as defined by no further instrumentation[9]

Technical Pearls​

  • Extend the Y well into healthy tissue. V-flap advancement only works if the triangle has perfusion and lax tissue beyond the stenotic segment
  • Incision depth is site-specific. Bladder-wall Y-V and superficial cutaneous scar release use different tissue planes; avoid applying a universal full-thickness rule across organs
  • In Granieri's seven-patient series, Firefly near-infrared imaging of cystoscope light localized the stenosis.[10]
  • Concurrent versus staged AUS. After redo VUA, the 2026 EAU guideline advises deferring AUS implantation because recurrent VUAS is harder to treat with a cuff in place; most authors wait at least three to six months to establish stable patency, although exact timing lacks consensus.[24]

Summary of Advantages Across Applications​

  • May preserve local tissue continuity in selected designs
  • Provides a useful geometric model for advancement, subject to anatomy and tension
  • Avoids graft harvest in selected repairs
  • The opposite running cutaneous Y-V variant may be repeated if axillary scar release is inadequate.[7]
  • Reported through open, laparoscopic and robotic approaches; endoscopic transverse mucosal realignment is a distinct Y-V-like procedure

See Also​

References​

1. Olbrisch RR. "Running Y-V Plasty." Ann Plast Surg. 1991;26(1):52–56. doi:10.1097/00000637-199101000-00008

2. Shaw DT, Li CS. "Multiple Y-V Plasty." Ann Plast Surg. 1979;2(5):436–440. doi:10.1097/00000637-197905000-00013

3. Lai CS, Lin SD, Tsai CC, Tsai CW. "Running Y-V Plasty for Burn Scar Contracture." Burns. 1995;21(6):458–462. doi:10.1016/0305-4179(95)00019-8

4. van Niekerk WJ, Taggart I. "The Size of the Y: The Multiple Y-V Plasty Revisited." Burns. 2008;34(2):257–261. doi:10.1016/j.burns.2007.03.019

5. Andrades PR, Calderon W, Leniz P, et al. "Geometric Analysis of the V-Y Advancement Flap and Its Clinical Applications." Plast Reconstr Surg. 2005;115(6):1582–1590. doi:10.1097/01.prs.0000160693.82527.d4

6. Pauchot J, Chambert J, Remache D, Elkhyat A, Jacquet E. "Geometrical Analysis of the V-Y Advancement Flap Applied to a Keystone Flap." J Plast Reconstr Aesthet Surg. 2012;65(8):1087–1095. doi:10.1016/j.bjps.2012.03.004

7. Lin TM, Lee SS, Lai CS, Lin SD. "Treatment of Axillary Burn Scar Contracture Using Opposite Running Y-V Plasty." Burns. 2005;31(7):894–900. doi:10.1016/j.burns.2005.04.028

8. Burm JS, Yang WY. "Modification of Running Y-V Plasty to Correct Bilateral Nostril Stenosis With a Circular, Linear Contracture." J Plast Reconstr Aesthet Surg. 2011;64(12):1665–1668. doi:10.1016/j.bjps.2011.04.038

9. Shamout S, Yao HHI, Mossa AH, Carlson KV, Baverstock RJ. "Persistent Storage Symptoms Following Y-V Plasty Reconstruction for the Treatment of Refractory Bladder Neck Contracture." Neurourol Urodyn. 2022;41(5):1082–1090. doi:10.1002/nau.24941

10. Granieri MA, Weinberg AC, Sun JY, Stifelman MD, Zhao LC. "Robotic Y-V Plasty for Recalcitrant Bladder Neck Contracture." Urology. 2018;117:163–165. doi:10.1016/j.urology.2018.04.017

11. Masumoto H, Horiguchi A, Shinchi M, et al. "Effectiveness of Y-V Plasty for Refractory Bladder Neck Stenosis After Transurethral Prostate Surgery." Int J Urol. 2025;32(4):434–440. doi:10.1111/iju.15676

12. Zang Z, Shao D, Zhang H, et al. "Extraperitoneal Laparoscopic Modified Y-V Plasty for the Treatment of Refractory Bladder Neck Contracture." J Vis Exp. 2022;(184). doi:10.3791/64011

13. Abo Youssef N, Obrecht F, Padevit C, Brachlow J, John H. "Short and Intermediate-Term Outcome of Robot-Assisted Inverted YV-Plasty for Recurrent Bladder Neck Stenosis — A Single Centre Study." Urology. 2023;175:196–201. doi:10.1016/j.urology.2023.02.011

14. Abramowitz DJ, Balzano FL, Ruel NH, Chan KG, Warner JN. "Transurethral Incision With Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis." Urology. 2021;152:102–108. doi:10.1016/j.urology.2021.02.035

15. Szydełko T, Kasprzak J, Lewandowski J, Apoznański W, Dembowski J. "Dismembered Laparoscopic Anderson-Hynes Pyeloplasty Versus Nondismembered Laparoscopic Y-V Pyeloplasty in the Treatment of Patients With Primary Ureteropelvic Junction Obstruction: A Prospective Study." J Endourol. 2012;26(9):1165–1170. doi:10.1089/end.2011.0642

16. Szydełko T, Kasprzak J, Apoznański W, Zdrojowy R. "Laparoscopic Anterior Y-V Pyeloplasty: A Valuable Treatment Option in Patients With Small or Intrarenal Pelvis." J Laparoendosc Adv Surg Tech A. 2010;20(7):627–630. doi:10.1089/lap.2010.0223

17. Szydełko T, Kasprzak J, Apoznański W, et al. "Comparison of Dismembered and Nondismembered Y-V Laparoscopic Pyeloplasty in Patients With Primary Hydronephrosis." J Laparoendosc Adv Surg Tech A. 2010;20(1):7–12. doi:10.1089/lap.2009.0210

18. Tsivian A, Tsivian M, Sidi AA. "The Y-V Pyeloplasty Revisited." Urology. 2010;75(1):200–202. doi:10.1016/j.urology.2009.08.062

19. Amón Sesmero JH, Delgado MC, de la Cruz Martín B, et al. "Laparoscopic Pyeloplasty: Always Dismembered?" J Endourol. 2016;30(7):778–782. doi:10.1089/end.2015.0800

20. Sennert M, Fawzy M, Wirmer J, Graumann C, Hadidi AT. "Y-V Meatoplasty: A Simple Novel Technique to Correct Meatal Stenosis." J Sex Med. 2025. doi:10.1093/jsxmed/qdaf236

21. Kim KS, King LR. "Method for Correcting Meatal Stenosis After Hypospadias Repair." Urology. 1992;39(6):545–546. doi:10.1016/0090-4295(92)90013-m

22. Caione P, Capozza N, De Gennaro M, et al. "Distal Hypospadias Repair by Urethral Sliding Advancement and Y-V Glanuloplasty." J Urol. 1991;146(2 Pt 2):644–646. doi:10.1016/s0022-5347(17)37882-5

23. Viegas V, Freton L, Richard C, et al. "Robotic YV plasty outcomes for bladder neck contracture vs. vesico-urethral anastomotic stricture." World J Urol. 2024;42(1):172. doi:10.1007/s00345-024-04814-8

24. European Association of Urology. "EAU Guidelines on Urethral Strictures: Disease Management in Males." 2026. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-males

25. Curtis J, Schrup S, Moring N, et al. "Transurethral incision with transverse mucosal realignment for the treatment of bladder neck contractures after benign prostate surgery; mid-term outcomes." Urology. 2026;online ahead of print. doi:10.1016/j.urology.2026.07.018

26. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. "Urethral Stricture Disease Guideline Amendment (2023)." J Urol. 2023;210(1):64–71. doi:10.1097/JU.0000000000003482

27. European Association of Urology. "EAU Guidelines on Urethral Strictures: Disease Management in Transgender Patients." 2026. https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-transgender-patients