Minimally invasive reconstruction of extensive mid-lower ureteral strictures using a bilateral Boari flap.

ABSTRACT

Objective: To describe and evaluate the technique using bilateral Boari flap ureteroneocystostomy (BBFUNC) for bilateral mid-lower ureteral strictures. Methods: We retrospectively reviewed five patients who underwent minimally invasive BBFUNC in our institution (Union Hospital, Wuhan, China) between July 2019 and December 2021. The bilateral ureters were mobilized and transected above the stenotic segments. The bladder was isolated and incised longitudinally from the middle of the anterior wall. Then, an inverted U-shaped bladder flap was created on both sides, fixed onto the psoas tendon, and anastomosed to the ipsilateral distal normal ureter. Following double-J stenting, the Boari flaps were tubularized, and the bladder was closed with continuous sutures. The patients' perioperative data and follow-up outcomes were collected, and a descriptive statistical analysis was performed. Results: No case converted to open surgery, and no intraoperative complication occurred. The median surgical time was 230 (range 203-294) min. The median length of the bladder flaps was 6.2 (range 4.3-10.0) cm on the left and 5.5 (range 4.7-10.5) cm on the right side. All patients had not developed recurrent ureteral stenosis during the median follow-up time of 17 (range 16-45) months and had a normal maximum flow rate after surgery. The median post-void residual was 7 (range 0-19) mL. The maximal bladder capacity was decreased in one (20%) patient. Conclusion: The present study demonstrates that minimally invasive BBFUNC is feasible and safe in treating bilateral mid-lower ureteral strictures, and the impact on lower urinary tract function is limited.