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Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience

  • Urology - Original Paper
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Abstract

Background

This study was designed to evaluate the feasibility of laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures of the middle and lower ureters. By observing its curative effect and prognosis, we can provide a safer and reliable treatment option for patients with middle and lower ureteral injury.

Methods

In this study, of the eight cases under study, five were diagnosed with long-segment ureteric strictures, one had long-segment ureteric avulsion, one was diagnosed with ureteral rupture caused by surgical injury of appendicitis, and the remaining one underwent ureterostomy after ureteral injury. The location of ureteral injury was in the middle lower segment. All eight patients underwent laparoscopic ureteral reimplantation with a Boari flap from January 2018 to October 2021. In this study, two patients were treated with a Boari bladder flap with psoas hitching. All procedures were performed by the same surgeon with over 20 years of experience in urological surgery.

Results

The mean length of ureteric avulsion or ureteric strictures was 7.94 cm (range, 4–15 cm). Laparoscopic ureteral reimplantation with a Boari flap was performed successfully between 120 and 240 min. The mean duration of postoperative hospital stay was 6 days, and no major complications related to the procedure in the perioperative period occurred. Postoperative follow-up showed no obvious hydronephrosis on computed tomography urography or urinary ultrasound in all eight patients. Postoperative reexamination did not reveal any significant hydronephrosis, urinary tract infection, or ureteral reflux, and none of the postoperative renal functions were abnormal.

Conclusions

Laparoscopic ureteral reimplantation with a Boari flap is safe and feasible for experienced physicians. In our case, the length/width ratio of bladder flap is more than 4:1, with good blood supply and no obvious complications, it provides a longer alternative length.

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Acknowledgements

This research was supported by grants from the National Natural Science Foundation of China (Grant No. 81874034), Natural Science Foundation of Shandong Province (No. ZR2021MH129), Medical Health Science and Technology Innovation Plan of Jinan (No. 201805038, 201907085 and 202134037), Sponsored by Natural Science Foundation of Shanghai (No. 21ZR1459500), Municipal Commission of Health and Family Planning Foundation of Shanghai (No. 202140413).

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Author notes

  1. Guanglei Zhang and Jiming Zhao have equally contributed to this work.

Authors and Affiliations

  1. Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China

    Guanglei Zhang, Jiming Zhao, Guiting Zhao, Zhihong Niu & Liang Sun

  2. Institute of Orthopaedic Basic and Clinical Transformation, University of Shanghai for Science and Technology, Shanghai, China

    Ping Liu

  3. The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China

    Ping Liu

Authors
  1. Guanglei Zhang
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  2. Jiming Zhao
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  3. Guiting Zhao
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  4. Zhihong Niu
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  5. Ping Liu
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  6. Liang Sun
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Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Liang Sun.

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Conflict of interests

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics committee approval was received for this study from Biomedical Research Ethic Committee of Shandong Provincial Hospital (SWYX: NO. 2021-566).

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Zhang, G., Zhao, J., Zhao, G. et al. Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience. Int Urol Nephrol 54, 1865–1870 (2022). https://doi.org/10.1007/s11255-022-03224-2

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  • DOI: https://doi.org/10.1007/s11255-022-03224-2

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