Reconstruction: Benign

Moderated Poster Session

MP14-8 - Robotic Y-V Plasty for Recalcitrant Bladder Neck Contracture

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 241

Introduction & Objective : To demonstrate the technique and the outcomes of robot assisted Y-V plasty bladder neck reconstruction (RYVBNR).

Methods : We present our technique for treatment of recalcitrant bladder neck contracture (BNC) in seven patients who underwent RYVBNR at our institution between March 2016 and September 2017. Indication for the procedure was incomplete emptying, recurrent urinary tract infections and dysuria. On follow-up, patients were assessed for clinical success by absence of infections, symptoms and cystoscopic evaluation. Robotic assisted dissection is performed to open the space of Retzius and mobilize the bladder. The cystoscope is passed to the level of the BNC, and FireflyTMtechnology is used to localize the BNC. The BNC is incised anteriorly, and a V-shaped bladder flap is advanced into the BNC in a Y-V plasty fashion (figure 1). We place a perioperative closed suction drain, which is removed before discharge, and a catheter which will be removed in the office at approximately two weeks.

Results : Six men with recalcitrant BNCs and one with recalcitrant vesicourethral anastomotic stenosis underwent treatment (figure 2). All patients had previously undergone an endoscopic procedure. Median time for last attempt at endoscopic management to RABNR was 4.7 months. The average number of prior attempts at endoscopic management was 2. All patients underwent RYVBNR without conversion to open surgery. The median operative time was 240min, estimated blood loss was 67 ml, and length of stay was 1 day. There were no intraoperative complications. Catheters were removed in the office at a median time of 15 days. At a median follow-up of 8 months, all cases were successful with no evidence of recurrence. Only two patients had persistent urinary incontinence at 1 pad per day.

Conclusions : RYVBNR with a Y-V plasty is a feasible and effective technique for managing a difficult reconstructive problem.

Lee C. Zhao

Assistant Professor
NYU Langone Health

Lee Zhao MD, MS is a reconstructive urologist at NYU Langone Health. Prior to becoming a physician, he attended graduate school for biomedical engineering and volunteered in the Peace Corps. Combining his interest in fixing problems and his desire to help people led him to the field of urologic reconstructive surgery—a field that focuses on restoring a person’s quality of life.
He works with a multi-disciplinary team of surgeons for the repair of urethral strictures, fistulae, and congenital abnormalities. As part of his reconstructive surgery practice, he performs both primary and revision gender affirming surgery—vaginoplasty, phalloplasty, urethroplasty, and fistula repair.

He has pioneered the use of robotic surgery for urologic reconstruction, such as repair of ureteral strictures using oral mucosa, and closure of fistulae. He has also adapted robotic technology for gender affirming surgery, using the Da Vinci robot for the deep pelvic dissection to facilitate increased vaginal depth for male-to-female patients, and improved outcomes of urethral lengthening for female-to-male patients. In addition to clinical care, Dr. Zhao is actively involved in studying improvements in surgical outcomes and patient safety by participating in collaborative research. He has authored numerous articles on urologic reconstruction, and has served as an author of the American Urologic Association guidelines on Urethral Stricture.


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    Michael Granieri


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      Aaron Weinberg

      Chesapeake Urology Associates, LLC


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        Geolani Dy


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          MP14-8 - Robotic Y-V Plasty for Recalcitrant Bladder Neck Contracture

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