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Y-V Plasty for BNC and VUAS

Y-V plasty advances a vascularized bladder-wall flap into an opened stenotic outlet. It can be performed open, laparoscopically or robotically. It is a reconstructive option for selected refractory bladder-neck stenosis or VUAS, not a guarantee against recurrent scarring or incontinence.[1][2][3]

Selection​

Define stenosis location, length, lumen, prior surgery/radiation, tissue quality, bladder function and baseline continence. EAU supports individualized specialist reconstruction for refractory posterior disease; repeated endoscopic treatment remains an option for selected nonobliterative recurrence. There is no universal rule to reconstruct after exactly two failures or to choose a flap solely by a 2 cm cutoff.[4]

A viable bladder flap must reach the opened outlet without tension. Obliteration, inadequate tissue or a long gap may require a different reconstruction. BNC after benign prostate surgery and VUAS after prostatectomy have different relationships to the remaining sphincter; discuss new or worsened SUI and possible later AUS treatment.[5][4]

Robotic anterior Y-V sequence​

The Granieri/Zhao description uses transperitoneal robotic exposure.[1]

  1. Develop the required retropubic exposure and mobilize the bladder while protecting adjacent structures.
  2. Localize the stenosis with cystoscopy. Firefly viewing of cystoscopic light is transillumination, not ICG injection. Fluorescence after administered ICG is a separate method.
  3. Open the stenosis anteriorly into viable urethra and extend the incision proximally onto the bladder to create the Y and its V-shaped bladder flap.
  4. Advance the flap's distally directed apex into the distal urethrotomy and suture viable mucosal edges without tension. The apex does not point proximally while being advanced distally.
  5. Close the remaining defect, assess hemostasis and watertightness, and establish catheter drainage. The index protocol used a 22 Fr catheter and approximately two weeks of drainage; adapt the plan to healing and operative findings.

Y-V plasty widens an opened outlet using tissue advancement; it is not synonymous with circumferential excision and primary reanastomosis. Exact scar excision and flap geometry depend on the chosen modification.

Variants​

Extraperitoneal robotic and laparoscopic modifications avoid intraperitoneal entry when feasible. Abo Youssef's extraperitoneal series reported median operative time 131 minutes; this does not prove faster surgery than Granieri's separate cohort.[2]

Zheng's 31-patient series selected short obliterative bladder outlets (no longer than 2 cm) without false passages or diverticula on MR evaluation. Its modified 5/7-o'clock incisions and layered barbed closure belong to a laparoscopic reconstruction, not a routine endoscopic-incision prescription. The series does not establish that barbed sutures reduce leaks or that MR urethrography is universally superior to RUG/VCUG.[6]

Results with study-specific definitions​

StudyPatients and follow-upFindings
Granieri 20187 patients: 6 BNC, 1 VUAS; median 8 monthsAll patent; two had persistent incontinence using one pad daily, not two proven new-incontinence events.[1]
Abo Youssef 202330 patients; median 27 monthsFive treatment failures at 24 months, of which two were restrictures. The 83.3% treatment-success endpoint is not simply anatomic patency. Two major complications reported.[2]
Viegas 202421 patients: 15 BNC, 6 VUASFive new SUI cases, all in the six-patient VUAS subgroup. This is a small subgroup signal, not an 83.3% universal VUAS risk or proof of zero BNC risk.[5]
Zheng 202431 selected short obliterative outlets28/31 patent; four postoperative SUI cases. Selection limits generalization to longer, fistulizing or radiated disease.[6]
Masumoto 20255 open post-TURP repairs; median 13 monthsAll patent; three used one to two pads postoperatively. The abstract does not establish all three as new-onset incontinence.[3]

These observational series differ in approach, anatomy and endpoints. Do not combine them into a ranking against BMG or direct reanastomosis. The TURNS cohorts and Zhang's 105-patient robotic series also mix reconstruction types; the latter's 28.6% AUS rate is not a BMG-specific new-SUI rate.[7][8][9]

Radiation and additional reconstruction​

Radiation injury affects tissue selection and healing, but small cohorts cannot establish a single strongest predictor across every technique. Bearrick's five irradiated patients had frequent reintervention and AUS use; Savun's small nonrandomized comparison does not prove that robotic access itself preserves continence better than perineal repair.[10][11]

When local tissue is inadequate, consider dorsal BMG, subtrigonal inlay, transvesical repair, reanastomosis, or combined reconstruction according to anatomy. Vascularized tissue interposition may be useful; omental, rectus and gracilis transfers require different harvest approaches, and a robotic urethroplasty does not imply robotic gracilis harvest.[12]

Complications and follow-up​

Discuss recurrent stenosis, leakage/fistula, infection, bleeding and incontinence. Serious osteitis/pubovesical fistula has occurred in robotic posterior reconstruction cohorts. Confirm healing and stable patency, then reassess storage function and continence before any AUS surgery. A reported high patency rate after selected repairs does not guarantee later device safety.[7][4]

Videos​

Robotic-Assisted Y-V Plasty of the Bladder Neck
AUA Core Curriculum (2023)

References​

1. 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

2. 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

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

4. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, sections 6.3.5–6.3.6. Guideline.

5. Viegas V, Freton L, Richard C, et al. "Robotic YV Plasty Outcomes for Bladder Neck Contracture vs. Vesico-Urethral Anastomotic Stricture." World Journal of Urology. 2024;42(1):172. doi:10.1007/s00345-024-04814-8

6. Zheng K, Sa Y, Hao C, et al. "Modified Y-V Plasty Based on MRU Evaluation for Iatrogenic Bladder Outlet Obliteration: A Multicentre Experience in China." World Journal of Urology. 2024;42(1):88. doi:10.1007/s00345-023-04765-6

7. Kirshenbaum EJ, Zhao LC, Myers JB, et al. "Patency and Incontinence Rates After Robotic Bladder Neck Reconstruction for Vesicourethral Anastomotic Stenosis and Recalcitrant Bladder Neck Contractures: The Trauma and Urologic Reconstructive Network of Surgeons Experience." Urology. 2018;118:227-233. doi:10.1016/j.urology.2018.05.007

8. Shakir NA, Alsikafi NF, Buesser JF, et al. "Durable Treatment of Refractory Vesicourethral Anastomotic Stenosis via Robotic-Assisted Reconstruction: A Trauma and Urologic Reconstructive Network of Surgeons Study." European Urology. 2022;81(2):176-183. doi:10.1016/j.eururo.2021.08.013

9. Zhang TR, Alford A, Wang A, Zhao LC. "Robotic-Assisted Posterior Urethroplasty: Outcomes From 105 Men in a Single-Center Experience." Urology. 2023;181:167-173. doi:10.1016/j.urology.2023.05.062

10. Bearrick EN, Findlay BL, Maciejko LA, et al. "Robotic Urethral Reconstruction Outcomes in Men With Posterior Urethral Stenosis." Urology. 2022;161:118-124. doi:10.1016/j.urology.2021.11.035

11. Savun M, Çolakoğlu Y, Özdemir H, et al. "Comparison of Open Perineal and Robot-Assisted Reconstruction in Vesicourethral Anastomotic Stenosis." World Journal of Urology. 2025;43(1):413. doi:10.1007/s00345-025-05808-w

12. Liu W, Shakir N, Zhao LC. "Single-Port Robotic Posterior Urethroplasty Using Buccal Mucosa Grafts: Technique and Outcomes." Urology. 2022;159:214-221. doi:10.1016/j.urology.2021.07.049