International braz j urol : official journal of the Brazilian Society of Urology · 2027
Robotic Totally Intracorporeal Bilateral Boari Flap Reconstruction for Complex Bilateral Ureteral Strictures: A Step-by-Step Technique.
СтатьяКлинический случайVideo-Audio MediaНазвание и аннотация: Перевод пока не подготовлен
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Chai Shuaishuai, Zhou Yuancheng, Hu Junwei, Liang Chaoqi, Xiao Xingyuan, Li Bing
Аннотация
PURPOSE: Boari flap reconstruction is effective for unilateral ureteral strictures (1-5), but its use for bilateral disease is rarely reported. Robotic surgery offers enhanced visualization and dexterity for complex ureteral reconstruction (4, 6-9). We describe robotic totally intracorporeal bilateral Boari flap (BBF) reconstruction for bilateral mid- and distal ureteral strictures (BMDUS).
MATERIALS AND METHODS: A 42-year-old woman with BMDUS underwent BBF reconstruction. The left ureter was dissected, ligated, and transected proximal to the stricture, then trimmed to healthy tissue until a 10-Fr catheter passed smoothly; the same steps were repeated on the right. After measuring each ureteral defect, bilateral inverted U-shaped bladder flaps were tailored and hitched to the ipsilateral psoas tendons. A double-J stent was placed in each ureter. The healthy proximal ureters were anastomosed to the corresponding flaps, and both flaps were tubularized with running sutures. The bladder was then closed and a drain was placed.
RESULTS: The procedure was completed successfully without conversion to open surgery. Operative time was 263 minutes, estimated blood loss was 55 mL, and bilateral 6-cm Boari flaps were created. The urinary catheter, double-J stents, and nephrostomy tubes were removed at 7 days, 5 weeks, and 6 weeks, respectively. At 12 months, bladder capacity was 352 mL, post-void residual volume was 8 mL, maximum flow rate was 26 mL/s, and eGFR had increased from 36.0 to 50.6 mL/min/1.73 m². At 35 months, the patient remained symptom-free with no late complications.
CONCLUSIONS: Robotic totally intracorporeal BBF reconstruction is technically feasible. Larger studies with long-term follow-up are warranted. Funding This research received funding support from the National Natural Science Foundation of China (82470724) and Zhongnan Hospital of Wuhan University (grant no. rcyj20230102 to Bing Li).
MATERIALS AND METHODS: A 42-year-old woman with BMDUS underwent BBF reconstruction. The left ureter was dissected, ligated, and transected proximal to the stricture, then trimmed to healthy tissue until a 10-Fr catheter passed smoothly; the same steps were repeated on the right. After measuring each ureteral defect, bilateral inverted U-shaped bladder flaps were tailored and hitched to the ipsilateral psoas tendons. A double-J stent was placed in each ureter. The healthy proximal ureters were anastomosed to the corresponding flaps, and both flaps were tubularized with running sutures. The bladder was then closed and a drain was placed.
RESULTS: The procedure was completed successfully without conversion to open surgery. Operative time was 263 minutes, estimated blood loss was 55 mL, and bilateral 6-cm Boari flaps were created. The urinary catheter, double-J stents, and nephrostomy tubes were removed at 7 days, 5 weeks, and 6 weeks, respectively. At 12 months, bladder capacity was 352 mL, post-void residual volume was 8 mL, maximum flow rate was 26 mL/s, and eGFR had increased from 36.0 to 50.6 mL/min/1.73 m². At 35 months, the patient remained symptom-free with no late complications.
CONCLUSIONS: Robotic totally intracorporeal BBF reconstruction is technically feasible. Larger studies with long-term follow-up are warranted. Funding This research received funding support from the National Natural Science Foundation of China (82470724) and Zhongnan Hospital of Wuhan University (grant no. rcyj20230102 to Bing Li).