Experience managing distal ureteral strictures with Boari flap-psoas hitch and comparison of open and laparoscopic procedures

The goals for management of ureteropelvic junction obstruction (UPJO) and ureteral stricture are to resolve obstruction, restore continuity, and preserve renal function while minimizing morbidity. The management of UPJO can be challenging and represents a spectrum of options that vary in the invasiveness and effective. These options include observation, long-term internal or external urinary drainage, and endoscopic or minimally invasive management. Mismanagement can potentially results in deterioration of loss of kidney function. This chapter discusses the foundations for successful management of UPJO and ureteral strictures. It also highlights the special clinical situations related to this disease entity and discusses the key advances in the field. This review contains 8 figures, 4 tables, and 73 references. Key Words: Boari flap, dismembered pyeloplasty, endopyelotomy, psoas hitch, pyeloplasty, ureteropelvic junction obstruction, ureteral obstruction, ureteral reconstruction, ureteral stricture, uretero-ureterostomy

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Uretero-transappendix-cystoneostomy as a technique for the reconstruction of the lower part of the ureter

Vojnosanitetski pregled ◽

10.2298/vsp0512931m ◽

2005 ◽

Vol 62 (12) ◽

pp. 931-933

Author(s):

Novak Milovic ◽

Pero Janjic ◽

Vladimir Bancevic ◽

Srdjan Kupresanin

Keyword(s):

Renal Function ◽

Case Report ◽

Surgical Techniques ◽

Large Defect ◽

Boari Flap ◽

Gun Shot ◽

Psoas Hitch ◽

The Right

Background. Any large missing part of the ureter may be replaced by transureteroureterostomy, psoas hitch, Boari flap, nephrectomy, renal autotransplanation or by the implementation of an intestinal graft. Case report. A patient with a defect of the lumbal- pelvic portion of the right ureter, after the management of a penetrating and perforating gun shot wound was presented. The missing part of the ureter was successfully replaced with an appendix. The technique of uretero-transappendixcystoneostomy complete with a Boari flap and a psoas hitch was used. Conclusion. By the use of an original combination of surgical techniques, a large defect of the ureter and the defect of the bladder, as well as the preservation of the renal function was achieved in a more successful manner.

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Urinary Tract Endometriosis

Journal of Endometriosis ◽

10.1177/228402650900100202 ◽

2009 ◽

Vol 1 (2) ◽

pp. 72-78 ◽

Cited By ~ 1

Author(s):

Peter Rehder ◽

Bernhard Glodny ◽

Renate Pichler ◽

Andrea Kerschbaumer ◽

Michael Mitterberger

Keyword(s):

Urinary Tract ◽

Ureteral Obstruction ◽

Genetic Disorder ◽

Large Area ◽

Distal Ureter ◽

Small Areas ◽

Boari Flap ◽

Bladder Endometriosis ◽

Psoas Hitch ◽

Symptoms And Signs

Endometriosis is a multifactorial polygenic genetic disorder that affects 10–20% of women. The urinary tract is affected in only 1–5% of cases and here most commonly the urinary bladder. Diagnosis of urinary tract endometriosis is made late due to its commonly asymptomatic course. The management of urinary tract endometriosis depends on the severity of the symptoms and signs, the extent of the disease, its location and the presence of renal damage because of ureteral obstruction. A conservative medical treatment is recommended for small areas of endometriosis in the bladder. For urinary tract endometriosis covering a large area, or where infiltration causes architectural damage, surgery is recommended. Partial cystectomy should be considered because of the transmural nature of bladder endometriosis. In cases of ureteral endometriosis, the surgical technique is determined by the location and extent of the lesion. For the distal ureter an ureterocystoneostomy using the Psoas hitch or Boari flap is recommended. For short, proximal ureteral involvement an end-to-end anastomosis or endoscopic incision may be used, and for extended areas, ileum interposition or kidney mobilization using nephropexy. A multidisciplinary approach is strongly recommended. Endometriosis with urological involvement more often needs surgical treatment, especially when ureteral obstruction leads to progressive kidney damage.

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Robotic-Assisted Ureteral Reimplantation with Boari Flap and Psoas Hitch: A Single-Institution Experience

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2011.0028 ◽

2011 ◽

Vol 21 (9) ◽

pp. 829-833 ◽

Cited By ~ 19

Author(s):

Christopher Yang ◽

Loren Jones ◽

Marcelino E. Rivera ◽

Graham T. VerLee ◽

Leslie A. Deane

Keyword(s):

Ureteral Reimplantation ◽

Single Institution ◽

Robotic Assisted ◽

Boari Flap ◽

Psoas Hitch

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Laparoscopic ureteroneocystostomy in iatrogenic injuries of ureter after gynecoloc operations

Journal of obstetrics and women s diseases ◽

10.17816/jowd64432-38 ◽

2015 ◽

Vol 64 (4) ◽

pp. 32-38

Author(s):

Bakhman Gidayatovich Guliev

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Distal Part ◽

Laparoscopic Hysterectomy ◽

Transperitoneal Approach ◽

Iatrogenic Injuries ◽

Boari Flap ◽

Ureteral Injuries ◽

Direct Anastomosis ◽

Psoas Hitch

The Objective. To evaluate outcomes of laparoscopic ureteroneocystostomy in patients with iatrogenic strictures of distal part of ureter, caused by gynecologic interventions. Materials and methods. From 2010 to 2014, 10 female patients with iatrogenic injuries of distal part of ureter underwent laparoscopic ureteroneocystostomy. Seven had previous open or laparoscopic hysterectomy, two - removal of endometrioid nodes and 1 - ovarial resection. Surgery was performed using transperitoneal approach with inserting of 4 trocars. Ureter was mobilized and transected above the stricture with subsequent extravesical implantation to the bladder. Results. We had no conversion cases and in all patients ureteroneocystostomy didn’t fail. In 3 cases intervention included ureteroneocystostomy with psoas-hitch, in 2 - Boari flap and in 5 - direct anastomosis of ureter with bladder. Average surgery time was 140 min (ranged between 110 and 215min), average blood loss was estimated as 160 ml (125-240 ml). Cystoureteral reflux was noted in 2 patients. Conclusion. Laparoscopic ureteroneocystostomy is less invasive and reliable surgical treatment modality efficient in cases of iatrogenic ureteral injuries due to gynecological interventions.

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MP61-13 MODIFIED PSOAS HITCH CAN REPLACE BOARI FLAP WITHOUT COMPROMISING VASCULARITY

The Journal of Urology ◽

10.1097/01.ju.0000556815.25608.d9 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Majid Mirzazadeh ◽

Whitney Smith*

Keyword(s):

Boari Flap ◽

Psoas Hitch

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Ureteral Reimplantation, Psoas Hitch, and Boari Flap

Journal of Endourology ◽

10.1089/end.2018.0750 ◽

2020 ◽

Vol 34 (S1) ◽

pp. S-25-S-30 ◽

Cited By ~ 2

Author(s):

Christine White ◽

Michael Stifelman

Keyword(s):

Ureteral Reimplantation ◽

Boari Flap ◽

Psoas Hitch

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Principles of reconstruction of the ureter with a Boari flap or psoas hitch

10.18591/bjuik.0092 ◽

2016 ◽

Keyword(s):

Boari Flap ◽

Psoas Hitch

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Early Repair of Pelvic and Abdominal Nonurological Surgery-Induced Iatrogenic Ureteral Injuries in Three Distinct Waiting-for-Repair Time Periods

The American Surgeon ◽

10.1177/000313481207801137 ◽

2012 ◽

Vol 78 (11) ◽

pp. 1270-1275 ◽

Cited By ~ 3

Author(s):

Jingquan Li ◽

Zhaoyan Chen ◽

Qingguo Zhu ◽

Yakun Zhao ◽

Haiping Wang ◽

...

Keyword(s):

Surgical Repair ◽

Ureteral Injury ◽

Therapeutic Effects ◽

Middle Segment ◽

Boari Flap ◽

Urological Surgery ◽

Ureteral Injuries ◽

Psoas Hitch ◽

Time Periods ◽

Iatrogenic Ureteral Injury

The purpose of this study was to explore whether the time from pelvic and abdominal non-urological surgery-induced iatrogenic ureteral injuries to repair associates with outcomes. We retrospectively reviewed 81 cases of pelvic and abdominal nonurological surgery-induced iatrogenic ureteral injuries occurring in 78 patients treated at our hospital from January 2000 to December 2009. Time between injury and surgical repair, operative times, and incidence of complications were compared. Lower ureteral segment injuries occurred in 66 cases, middle segment injuries in 13, and upper segment injuries in two. Surgical repair methods included 36 ureteroneocystostomies, 17 ureteroneocystostomy with psoas hitch, 14 ureteroureterostomies/ureteral end-to-end anastomosis, and 10 ureteroneocystostomies with a Boari flap. Immediate intraoperative repair was carried out in 23 cases. In 42 cases, repair was delayed as a result of late identification and performed within 1 month after surgery. In 10 cases, repair was performed 3 months after surgery. No significant differences were observed in operative times of repair surgeries or incidence of postoperative complications. Delayed discovery of iatrogenic ureteral injury can still result in good therapeutic effects if the surgical repair is done within 1 month after injury under the premise that no serious urinary tract infection is present and the patient can tolerate surgery.

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