Re-do Boari flap for recurrent ureteric stricture

Sionov, Ben Valery; Taha, Tarek; Preter, Dmitry; Salbaq, Ramzi Antonio; Engelstein, Dov; Tsivian, Alexander

doi:10.1590/s1677-5538.ibju.2020.0491

Cited by 3 publications

(13 citation statements)

References 9 publications

(3 reference statements)

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“…8,9 However, there is limited literature available on surgical outcomes associated with this technique. 10,11 Reported complications include urinary leak, uroperitoneum (Clavien-Dindo grade ≥2) and uretero-vaginal and uretero-enteric fistula (Clavien-Dindo grade ≥3), as well as late complications such as anastomotic strictures with recurrent hydronephrosis (Clavien-Dindo grade ≥3), which may require permanent stents, nephrostomy tubes or even nephrectomy. 10,11,16 Various authors have documented their experiences with the Boari flap technique, providing insights into outcomes, success rates and complication rates.…”

Section: Resultsmentioning

confidence: 99%

“…The Boari flap has been widely used as a method of ureteroneocystostomy for bridging longer segments of the ureter 8,9 . However, there is limited literature available on surgical outcomes associated with this technique 10,11 . Reported complications include urinary leak, uroperitoneum (Clavien–Dindo grade ≥2) and uretero‐vaginal and uretero‐enteric fistula (Clavien–Dindo grade ≥3), as well as late complications such as anastomotic strictures with recurrent hydronephrosis (Clavien–Dindo grade ≥3), which may require permanent stents, nephrostomy tubes or even nephrectomy 10,11,16 …”

Section: Discussionmentioning

confidence: 99%

“…3. Most of these studies consist of small case series, such as Ben Sionov et al, 11 Yucai Wu et al, 12 Alsaadi et al, 20 Farzad et al 21 and AbdelBakayko et al 22 4. The length of the ureteric segment has not been mentioned in many reports, including those by Ben Sionov et al, 11 Wenske et al, 26 Gozen et al 24 and AbdelBakayko et al 22 All of these limitations make it exceedingly challenging to make an objective assessment of the success of the Boari flap procedure based on the available literature.…”

Section: The Followmentioning

confidence: 99%

“…The Boari flap, or ureteroneocystostomy using a raised bladder flap, is still widely used by urologists for the reconstruction of ureteric injuries in both longer segments 8 and further locations up to mid and proximal ureter, 9 with relatively favourable outcomes in long‐term follow‐up. Despite the versatility of its indications and common use in urological surgeries, there is currently scarce literature considering the outcomes and complications of the Boari flap procedure 10,11 . Complications, mostly anastomotic stricture and leakage, can arise from the technique itself in which incision is made on three sides of the flap and blood supply is exclusively driven from the flap's base.…”

Section: Introductionmentioning

confidence: 99%

“…These factors interfere with the proper blood supply and healing process, ultimately leading to a higher rate of failure. Management of complications after the Boari flap is usually very challenging and includes re-doing Boari flaps 11 ileal ureter, new techniques for ureteral grafts 12 or permanent stents or nephrostomy tubes and nephrectomy as the last resort.…”

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confidence: 99%

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Newly modified ‘pseudo flap’ without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database

Mirzazadeh,

Badran,

Smith

2024

BJUI Compass

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ObjectiveTo present an alternative technique called pseudo‐flap for reconstructing long ureteral defects as an alternative to Boari flap. Despite being used for more than 70 years by urologists for tension‐free reconstruction of distal and mid‐ureteral defects, the Boari flap exhibits high complication rates, with an average of 27% (range 5.5%–30.4%). These complications arise from compromised blood supply, attributed to incisions made on all three sides of the flap and dependence on the flap base as the sole source of blood supply.MethodsWe retrospectively reviewed patients who underwent our modified technique by a single surgeon between 2008 and 2021. We used a semi‐oblique cystotomy on the lowest part of the anterior and contralateral aspects of the bladder after complete release from adhesions and sacrificing the superior vesical pedicle, if necessary. The innovative part of the technique involved making short relaxing incisions at different levels on both sides of a pseudo‐flap while pushing the bladder dome upward to reach the healthy ureter in a tension‐free manner, followed by anastomosis with a non‐refluxing or refluxing technique.ResultsFifteen patients underwent the pseudo‐flap technique with a mean follow‐up of 16.9 months. Four had prior radiation, three had hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis, and one had a ureteral stricture in a transplanted kidney. Eight procedures were performed during intraoperative consultations.Only one patient (7%) developed a major complication (Clavien–Dindo grade ≥2). This patient developed postoperative leak, and none developed obstructive hydronephrosis, suggesting stricture or flap ischemia. The mean length of the flap was 9.3 cm.ConclusionOur pseudo‐flap technique has lower complication rates than the traditional Boari flap. It is not technically challenging, minimally compromises blood supply and is thus especially suitable for complex, highly morbid patients with decreased tissue vascularity, such as those with prior radiation and peritoneal carcinomatosis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: The Followmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Newly modified ‘pseudo flap’ without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database

Mirzazadeh,

Badran,

Smith

2024

BJUI Compass

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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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Yang-Monti ileal ureter: An approach to complex upper urinary tract reconstruction – A case report and literature review

Ocampo

Cabrera

2023

International Journal of Reconstructive Urology

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Complex ureteral stricture is a challenge for the reconstructive urologist, the surgical technique depends on the length of the segment. Surgical expertise is fundamental due to the limited surgical management in this scenario. We aim to describe the surgical technique and long-term follow-up of complex ureteral injury reconstruction with the Yang-Monti ileal ureter approach, which can be achieved successfully. A literature review was made using Medscape, Embase, and SciELO databases. We describe the cases of two female patients who had complex ureteral injury after urological procedures. Due to the extent of the ureteral stricture, the Yang-Monti ileal ureter was the best option to preserve renal function successfully in these patients. The Yang-Monti ileal ureter is a feasible surgical technique for the reconstruction of complex ureteral strictures when other approaches have failed. The right selection of patients is fundamental to achieving good results.

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Re-do Boari flap for recurrent ureteric stricture

Cited by 3 publications

References 9 publications

Newly modified ‘pseudo flap’ without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database

Newly modified ‘pseudo flap’ without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database

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

Yang-Monti ileal ureter: An approach to complex upper urinary tract reconstruction – A case report and literature review

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