“…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.…”
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.
“…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.…”
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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