Laparoscopic ureteral replacement by Boari flap: Multi-institutional experience in 30 cases

Castillo, Octavio A.; Travassos, José; López-Fontana, Gastón

doi:10.1016/j.acuroe.2012.11.020

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…As techniques have developed, minimally invasive methods have been widely used in ureteral reconstruction. Several teams have performed ureteral reimplantation involving the Boari flap in laparoscopic approaches, as shown in Table 4 (6,19,(21)(22)(23)(24)(25). In our research, the first laparoscopic Boari flap-psoas hitch procedure was performed in November 2015, and more patients have been treated using laparoscopic procedures in recent years.…”

Section: B a D Cmentioning

confidence: 99%

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Ding¹,

Cheng²,

Li³

et al. 2021

Transl Androl Urol

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Background: To summarize our experience with the Boari flap-psoas hitch and compare the indications, perioperative data and outcomes between open and laparoscopic procedures. Methods: This study retrospectively reviewed 35 patients with complex distal ureteral stricture between January 2015 and April 2019. All patients were treated with Boari flap-psoas hitch by either an open or a laparoscopic procedure. Selection criteria were based on the etiology, comorbidities, medical history, and patient preference. Results: All surgeries were performed successfully. The median operation time was 201 min (range, 120 to 300 min), and the median estimated blood loss was 50 mL (range, 20 to 400 mL). The median postoperative hospitalization was 9 days (range, 3 to 46 days). Nineteen patients were treated by the open procedure, and 16 were treated by the transperitoneal laparoscopic procedure. The surgical indication of open surgery was broader than that for laparoscopic surgery. For patients experiencing iatrogenic injury and ureterovesical reimplantation failure, no significant differences in sex, laterality, operative time, ASA score or postoperative hospitalization stay were observed between the two groups. The median estimated blood loss was lower in the laparoscopic group than in the open group (P=0.047). Patients in the open group had more surgical complications than patients in the laparoscopic group (P=0.049). The postoperative follow-up showed the radiological resolution of hydronephrosis in 33 patients. Conclusions: With the appropriate surgical considerations, Boari flap-psoas hitch is a valid method to bridge distal ureteral defects. For select patients, laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.

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Section: B a D Cmentioning

confidence: 99%

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Ding¹,

Cheng²,

Li³

et al. 2021

Transl Androl Urol

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“…Fugita OE et al (5)performed the first successful laparoscopic Boari flap in three patients with long-segment ureteral stricture in 2001 and confirmed that the procedure was effective and feasible.Ding G et al (20)retrospectively reviewed 35 patients with complex distal ureteral stricture.compared to open Boari flap-psoas hitch,laparoscopic surgery had advantages being a minimal invasive surgery with less estimated blood loss and fewer surgical complications.We summarize some of the teams that performed Boari flap in the laparoscopic approach,as shown in Table 3 (9,(21)(22)(23)(24)(25)(26)(27).In our study,perioperative outcomes were similar to them.During long-term follow-up,one patient developed ureteral stricture and severe hydronephrosis one year after surgery,and hydronephrosis was reduced after placement of 2 double J-tubes,and one patient had recurrent urinary tract infection,while the remaining fifteen cases did not show any abnormalities.Damage to the blood supply to the bladder flap during surgery,operator's unskilled suturing technique,the patient's own nutritional status,and poor control of diabetes mellitus may have been associated with ureteral stenosis in this patient.In recent years,robot-assisted Boari flap has been reported,and its efficacy and safety have been confirmed (28,29).However,its high price is prohibitive.…”

Section: Discussionmentioning

confidence: 64%

Laparoscopic Boari flap for repair of long-segment ureteral avulsion or ureteral stricture: our experience with seventeen cases

Luo¹,

Deng²,

Wu³

et al. 2023

Preprint

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Objective: This study was designed to evaluate the safety and clinical efficacy of using laparoscopic Boari flap for repair of long-segment ureteric avulsion or ureteric stricture of the middle and lower ureters,and to summarize the experiences.We can providing a safe and viable treatment option for patients with middle and lower ureteral defects. Methods: We retrospectively collected data from seventeen patients who underwent laparoscopic Boari flap for repair of long-segment ureteral defects between October 2018 and March 2023,six of whom underwent Boari flap-psoas hitch,and assess patient demographic characteristics,intraoperative variables,postoperative complications,and follow-up outcomes. Results: The median length of ureteral avulsion or ureteral stricture was 8 cm(range,3-16 cm).The median operative time was 180 min(range,155-240min).The median estimated blood loss was 150mL(range,20-200 mL). The median postoperative hospital stay was 9 days(range,7-17 days),with no major procedure-related complications in the perioperative period.Postoperative follow-up (rang,1-65months) CTU or ultrasonography showed that one patient developed ureteral stricture and severe hydronephrosis 1 year after surgery,and the hydronephrosis improved 3 months after placing 2 double J-tubes.The remaining sixteen patients showed no significant complications on postoperative review. Conclusion: Laparoscopic Boari flap for repair of long-segment ureteric avulsion or ureteric stricture of the middle and lower ureters has good safety and feasibility.For ureteral avulsion,we prefer the psoas minor tendon as the recommended anchor for bladder suspension to avoid the femoral or genitofemoral nerve and the length-to-base ratio of the flap was up to 4:1 with good blood supply.

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“…In addition to benign ureter lesions, bladder flap could also be performed for treating transitional cell carcinoma 29 . With the popularity of minimally invasive techniques, LUCBF has been performed by several centers for various indications, as depicted in Table 4 4 , 21 , 22 , 25 , 30 . Our outcomes were equivalent to the results of these studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ureteroneocystostomy with bladder flap for benign ureteral stenosis: our initial experience

Zhang,

Huang,

Xie

et al. 2024

Sci Rep

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To present our experience with laparoscopic ureteroneocystostomy with bladder flap (LUCBF) for treating benign ureteral stenosis and evaluate its feasibility and efficacy. The clinical data of 27 patients with benign ureteral stenosis who underwent LUCBF were retrospectively analyzed. After identification and excision of the ureteral stenosis segment, the healthy ureteral stump was dissected and incised longitudinally. A U-shaped or spiral bladder flap was harvested from the anterolateral bladder wall for ureteroplasty. All patients underwent LUCBF successfully, including 14 patients were combined with psoas hitch technique, between 90 and 220 min (median, 155 min). The median length of ureteral defect was 6 cm (range, 5–17 cm). The median blood loss was 40 ml (20–150 ml). The median indwelling time of double-J stent was 8 weeks (range, 4–8 weeks). Five patients (10.6%) suffered postoperative complications during the follow-up period (range, 12–48 months), including fever, hematuria, urinary tract infection and recurrent stenosis. The success rate was 96.3% (26/27). Patients with long ureter defects had longer operative time and more blood loss than short ureter defects. LUCBF was a safe and feasible technique for benign ureteral stenosis. Long ureter defect was related to longer operative time and more blood loss.

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Laparoscopic ureteral replacement by Boari flap: Multi-institutional experience in 30 cases

Cited by 7 publications

References 15 publications

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

Laparoscopic Boari flap for repair of long-segment ureteral avulsion or ureteral stricture: our experience with seventeen cases

Laparoscopic ureteroneocystostomy with bladder flap for benign ureteral stenosis: our initial experience

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