T-Plasty for Recurrent Bladder Neck Stenosis
T-plasty is an open modification of Y-V plasty that advances two bladder-wall flaps into a recurrent stenotic outlet. The Hamburg reports describe selected patients after transurethral surgery for benign prostatic obstruction. Their encouraging results do not establish the best technique or extend automatically to post-prostatectomy VUAS or radiation injury.[1][2]
Operative concept
Through retropubic exposure, the stenosis is identified and opened into a viable urethral lumen. The modified bladder-wall incision creates two flaps that are advanced into the opened outlet and secured without tension. Preserve bladder-wall vascularity, protect the sphincter and ureteral orifices, close the bladder defect and establish drainage. The original publications provide the specific incision geometry.[1][2]
The two-flap design aims to provide tissue for widening. It has not been shown to offer a superior blood supply, a reliable “backup” if one flap fails, or better patency than a single-flap repair. The need for additional reconstruction, interposition and catheter duration depends on the actual defect and healing assessment.
Published cohorts
The two reports overlap. Do not add 10 and 30 to claim 40 independent patients. The expanded study identified all T-plasty patients at the center between December 2008 and July 2016.[1][2]
| Report | Population and follow-up | Result |
|---|---|---|
| Reiss 2016, index report | 10 highly recurrent post-BPH-surgery stenoses; mean follow-up 26 months | All 10 reported successful; no new stress incontinence or severe complications reported |
| Rosenbaum 2017, expanded cohort | 30 operated, including 25 after TURP; 3 lost to follow-up; median follow-up 45 months | 27/27 evaluable patients successful; one new incontinence case; no severe perioperative complications reported |
In the expanded cohort, paired flow measurements were available for only six patients (Qmax 6.79 to 24.42 mL/s) and paired residual measurements for ten (140.77 to 14.5 mL). Patient-reported satisfaction was favorable. These subset improvements are not measurements from all 30 patients.[1]
Interpretation
The main evidence is one center's evolving experience, with limited numbers and incomplete follow-up. The observed 100% result applies to the evaluable cohort; it is not a guarantee or evidence of superiority over Y-V plasty, BMG or other reconstruction. Forty-five months is useful follow-up but should not be called the longest follow-up of any bladder-neck reconstruction.
The 107-patient Angulo dorsal-BMG cohort sometimes used as a comparator concerned membranous/bulbomembranous stenoses after benign prostate surgery and excluded bladder-neck contracture. It therefore cannot be used to rank BMG against T-plasty for BNC.[3]
Patient selection
Consider reconstruction for recurrent stenosis when repeated endoscopic treatment is no longer acceptable or appropriate. Assess the residual lumen, stenosis length, prior operations, radiation, bladder capacity/compliance, continence and available viable tissue. There is no universal requirement to reconstruct after exactly two failures, and the original T-plasty evidence should not be presented as validation in radiated VUAS.[4]
TUIBNC, Y-V plasty, BMG augmentation, and reanastomosis belong to an individualized anatomical decision, not an evidence-based ranking of case-series success percentages.
References
1. Rosenbaum CM, Dahlem R, Maurer V, et al. "The T-Plasty as Therapy for Recurrent Bladder Neck Stenosis: Success Rate, Functional Outcome, and Patient Satisfaction." World Journal of Urology. 2017;35(12):1907-1911. doi:10.1007/s00345-017-2089-2
2. Reiss CP, Rosenbaum CM, Becker A, et al. "The T-Plasty: A Modified YV-Plasty for Highly Recurrent Bladder Neck Contracture After Transurethral Surgery for Benign Hyperplasia of the Prostate: Clinical Outcome and Patient Satisfaction." World Journal of Urology. 2016;34(10):1437-42. doi:10.1007/s00345-016-1779-5
3. Angulo JC, Dorado JF, Policastro CG, et al. "Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra After Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes." Journal of Clinical Medicine. 2021;10(17):3969. doi:10.3390/jcm10173969
4. European Association of Urology. EAU Guidelines on Urethral Strictures. 2026. Disease management in males, sections 6.3.5–6.3.6. Guideline.