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Laparoscopic Boari Flap Ureteral Reconstruction

Minimally invasive bladder flap reconstruction for long-segment distal ureteral defects.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Laparoscopic Boari Flap Ureteral Reconstruction?

Laparoscopic Boari flap reconstruction is a minimally invasive procedure to bridge long-segment defects of the distal ureter (8-15 cm) when primary anastomosis or psoas hitch is insufficient. A wide-based, tubularized bladder flap is mobilized, rotated cephalad and tunneled antirefluxively to the proximal ureteral end.

Indications include iatrogenic ureteral injury during gynecologic or pelvic surgery, ureteral stricture from radiation or stone disease, ureteral malignancy requiring distal ureterectomy, and selected congenital anomalies. The laparoscopic or robotic approach offers reduced postoperative pain, faster recovery and equivalent oncological and functional outcomes compared with open surgery.

Symptoms

Long-segment distal ureteral defect (8-15 cm)
Iatrogenic ureteral injury post-hysterectomy
Distal ureteral stricture from radiation
Recurrent stricture after endoscopic management
Distal ureteral urothelial carcinoma requiring resection
Failure of psoas hitch alone for long defect
Persistent flank pain and hydronephrosis

Risk Factors

Prior pelvic or abdominal surgery
Pelvic radiation therapy
Endometriosis with ureteral involvement
Recurrent urolithiasis
Distal ureteral malignancy
Connective tissue disorders affecting healing
Diabetes mellitus and impaired wound healing

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suspected ureteral injury during pelvic surgery
  • Persistent hydronephrosis after stent removal
  • Recurrent flank pain and infection
  • Imaging showing long distal ureteral stricture
  • Failed endoscopic stricture management
  • Need for distal ureterectomy for malignancy

Treatment Methods

01
Preoperative ureteroscopy and retrograde pyelography for stricture mapping
02
CT urography for length and location assessment
03
Cystoscopy and bladder capacity evaluation
04
Laparoscopic mobilization of bladder dome
05
Creation of wide-based bladder flap with adequate length
06
Cephalad rotation and tubularization over double-J stent
07
Antirefluxive submucosal tunnel ureteroneocystostomy
08
Watertight closure with absorbable suture
09
Postoperative drain, stent for 6-8 weeks, follow-up imaging

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.