Laparoscopic Y-V pyeloplasty

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Describtion


Foley Y-V Plasty


The Foley Y-V plasty (Fig. 15.11) is best used in cases with a high
insertion of the ureter, particularly in the absence of a dysplastic
upper ureter/UPJ segment. It requires more conceptual visualization
of the remodeling than does a dismembered repair.
The ureter and lower pelvis are freed up of fat and inflammatory
rind with preservation of its adventitia (Fig. 15.9A). The
ureter is pulled cranially with a vessel loop. A long Y-shaped incision
in marked between stay sutures (see Fig. 15.9B). The pelvis
is incised between the sutures using a hooked scalpel blade and
opened further with Potts scissors. The limbs of the V-flap on the
pelvis should be equal in length to the ureteral incision. A nephrostomy
tube or internal stent can be placed at this point.
The apex of the V-flap is sutured to the apex of the ureteral

incision using 6-0 SAS (see Fig. 15.9C). Each limb of the flap is
then sewn down with interrupted 5-0 or 4-0 SAS to create a
watertight anastomosis (see Fig. 15.9D, E). This can alternatively
be closed with running suture, taking care to avoid “dog-ears.”


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