LESSON 3: Procedures in Genitourinary Surgery

Section Iv: operations on the bladder and prostate

3-26

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3-26. BLADDER NECK OPERATION (Y-V-PLASTY)

a. General. This operation involves the plastic repair of the bladder neck. It is done to overcome contracture of the bladder neck due to primary or secondary stricture.

b. Operative Procedure.

(1) The bladder is approached as for cystostomy. The prevesical fat is removed, using long forceps and dissecting scissors. The vessels over the bladder neck are occluded with right-angled clamp, ligated with number 2-0 plain gut, and divided. The self-retaining bladder retractor is placed.

 

(2) Traction sutures of fine silk on small, fine, cutting-edge needles (cleft palate-type) are placed at the base and on either side of the urethra to start the pattern for the plastic dissection.

 

(3) With the aid of the traction sutures and an Allis forceps, the Y is incised through all layers as evenly as possible, using sharp-pointed scissors. Bleeding vessels in the wall of the bladder and bladder neck are ligated with plain number 2-0 gut on small Ferguson needles. The V flap is folded free, and the length of the Y arm is determined with a caliper and ruler.

 

(4) The apex of the V is brought to the neck of the bladder to overcome the stricture and broaden the outlet. A catheter is placed in the urethra to guide the needle and prevent the suture from penetrating the urethral mucosa. A stitch of chromic number 2-0 suture is taken through the apex of the V under the urethra to the base of the Y and tied. The closure of the plastic repair is completed with mattress suture of number 2-0 chromic on Atraumatic needles.

 

(5) A cystostomy tube is placed in the bladder, and the bladder and abdominal wall are closed in the usual manner for cystostomy.

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