Replacement of the ureter using the urinary bladder

Management of Complete Ureteral Replacement: Experiences and Review of the Literature

“…For this reason the indication of ileum interposition in cases of a damaged ileum after radiation should be subject to strict criteria in future. Complete ureteral replacement using a Boari flap to the renal pelvis, including psoashitch fixation, showed good results not only in animal experiments but also in patients with reduced renal functions (12,18). The necessary precondition for the performance of this surgical technique is sufficient bladder capacity.…”

“…Necessary preconditions include sufficient bladder capacity (volume >300ml) as well as the mobilization and caudal displacement of the kidney involved (4,12,17). In cases of extremely long strictures and/or insufficient bladder capacity, lesions should be bridged by the interposition of a suitably prepared ileal segment (2,3,6,7,11,19,21,28,29).…”

Technical Options in Complex Ureteral Lesions: 'Ureter-Sparing' Surgery

“…The use of the bladder as a ureteral substitute has been proposed since the classic work of Casati and Boari [21], The modi fication suggested by Kelamy [22], and subsequently widely employed by Olsson and Norlen [12] in clinical practice, represents a further improvement insofar as it allows the substitution of up to 18 cm of ureteral length. However, these techniques did not include an antireflux…”

Bladder Z‐plasty for the Repair of Ureteric Injuries Experimental Study in Sheep

“…Moreover, comparison between the various bladder elongation procedures has shown that the bladder psoas hitch, suggested by Witzel in 1896 and popularised by Turner-Warwick and Worth (1969), is safer and more effective than the Boari flap or the Demel technique.Unfortunately, the bladder psoas hitch procedure does not allow the bridging of extensive injuries which involve both the middle and the lower third of the ureter. In such cases a combined Boari flap and bladder psoas hitch can be used (Kelami et al, 1973;Olsson and Norlen, 1986), but the risk of complications is high.As a means of obtaining an equally safe but longer bladder elongation than the psoas hitch can provide, the mechanism of bladder elongation in the psoas hitch procedure was studied on isolated pig bladders. It was found that bladder elongation was 75% due to stretching of the bladder and 25% due to the bladder incision; it was impossible to stretch the bladder further, but attempts were made to find a more advantageous bladder incision by using different Z-shaped incisions.In the present study, a Z-plasty was performed in sheep in order to evaluate its efficacy and safety.…”

“…Accepted for publication 26 March 1992 Unfortunately, the bladder psoas hitch procedure does not allow the bridging of extensive injuries which involve both the middle and the lower third of the ureter. In such cases a combined Boari flap and bladder psoas hitch can be used (Kelami et al, 1973;Olsson and Norlen, 1986), but the risk of complications is high.…”