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Effectiveness of Y-V-plasty for refractory bladder neck stenosis after transurethral prostate surgery
Hakaru Masumoto1, Akio Horiguchi1,2, Masayuki Shinchi1
1Department of Urology, National Defense Medical College, Saitama, Japan.
Objectives:
To evaluate the surgical and patient-reported outcomes of YV-plasty in patients with refractory bladder neck stenosis (BNS) following transurethral prostate surgery.
Methods:
This retrospective study reviewed five patients who underwent YV-plasty for BNS between January 2021 and October 2023. The surgical procedure involved a midline lower abdominal incision to expose the bladder neck. A V-shaped incision was made in the anterior bladder wall to create a bladder flap. The bladder neck was then incised from the apex of the V-shape to the healthy urethra, forming a Y-shaped incision. Fibrotic tissue was excised, and the posterior side of the urethra and bladder were anastomosed. The bladder flap was mobilized and sutured to the healthy urethra using 4-0 PDS interrupted sutures. Follow-up assessments included uroflowmetry, postvoid residual urine volume measurement (PVR), and questionnaires on daily pad use and patient satisfaction. Success was defined as cystourethroscope passage through the anastomosis without resistance and no need for additional procedures.
Results:
The median patient age was 69. All patients had a history of failed endoscopic treatments. The median follow-up was 13 months, with all considered successful. The median postoperative maximum flow rate was 26.6 mL/s, and the median PVR was 12 mL. Postoperatively, two (40%) were pad-free, and three (60%) used 1-2 pads daily. Three (60%) patients were 'very satisfied,' one (20%) 'satisfied,' while one (20%) was 'dissatisfied.'
Conclusions:
Y-V-plasty is an effective option for refractory BNS, improving urinary function and quality of life.
