Combined Y-shaped common channel transureteroureterostomy with Boari flap to treat bilateral long-segment ureteral strictures

Abstract

BackgroundUreteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures.Case presentationA 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully.ConclusionReconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures.

A Case of Bilateral Duplicated Ureter - Gross Anatomy

“…In the complete type [5,6], two superior and two inferior segments empty separately into the bladder [1][2][3][4][7][8][9][10][11]. In the incomplete type, two superior and two inferior segments merge to form a Y stem emptying through a single orifice [8,12]. In the complete type, the SS opens into the bladder at a lower level than the IS (the Weigert-Meyer law) [13,14].…”

Salvage repair of rare iatrogenic bilateral ureteral injury after hysterectomy

“…Although recent novel techniques with reasonable outcomes were reported, current results are limited and there is no obvious consensus on bilateral ureteral repair due to a poverty of evidence supporting one particular treatment modality. [4,5] In addition, endourological techniques and equipment has been increasingly utilized in managing post-operative ureteric injuries. [6,7] In the above case, we elected for an open approach because an important consideration in bilateral ureteric injury is to preserve renal function.…”