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Although the Boari flap technique is commonly described in the literature as a method for primarily distal and middle ureteral injuries, it can also be used for reconstructing the proximal segment of the ureter. In this case study, we present a patient who underwent gynecological surgery with subsequent damage to the proximal ureter, and who underwent ureteral reconstruction using methods such as kidney mobilization, Boari flap, and psoas hitch. The postoperative period was uncomplicated, and after a six-month follow-up, the reconstructed ureter is functioning well, and the patient is in good health.
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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.
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Ureteral strictures can occur along the entire course of the ureter and have many different causes. Factors involved in the development include, among other things, congenital anomalies, iatrogenic injuries during endoscopic as well as open or minimally invasive visceral surgical, gynecological, and urological procedures as well as prior radiation therapy. Planning treatment for ureteral strictures requires a detailed assessment of stricture and patient characteristics. Given the various options for ureteral reconstruction, various methods must be considered for each patient. Short-segment proximal strictures and strictures at the pyeloureteral junction are typically surgically managed with Anderson-Hynes pyeloplasty. End-to-end anastomosis can be performed for short-segment proximal and middle ureteral strictures. Distal strictures are treated with ureteroneocystostomy and are often combined with a Boari and/or Psoas Hitch flap. Particularly, the treatment of long-segment strictures in the proximal and middle ureter remain a surgical challenge. The use of bowel interposition is an established treatment option for this, offering good functional results but also potential associated complications. Robot-assisted surgery is increasingly becoming a minimally invasive treatment alternative to reduce hospital stays and optimize postoperative recovery. However, open surgical ureteral reconstruction remains an established procedure, especially after multiple previous abdominal operations.
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Procedimientos de Cirugía Plástica , Uréter , Obstrucción Ureteral , Humanos , Uréter/cirugía , Constricción Patológica/cirugía , Obstrucción Ureteral/cirugía , Colgajos Quirúrgicos/cirugíaRESUMEN
In recent years, ureteral repair and reconstruction techniques, such as appendiceal onlay flap, oral mucosal patch for repairing middle and upper ureteral stenosis, and Boari bladder muscle flap for repairing lower ureteral stenosis, have been continuously introduced and widely used to achieve satisfactory clinical results.In clinical practice, it is important to carefully select suitable patients and adequately prepare for the perioperative period. Factors to consider include the surgical approach, planning the sequence of left and right reconstruction, to ensure optimal results for ureteral repair. This paper provides a detailed account of our center’s experience, reviews relevant literature on robot-assisted appendix graft ureteroplasty combined with Boari flap ureteroplasty for one-stage repair of bilateral ureteral strictures, and discusses the current clinical progress.
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OBJECTIVES: The objective is to discover the etiopathogenesis of benign lower ureteric stricture in Eastern India and compare the outcome of open versus laparoscopic ureteroneocystostomy. MATERIALS AND METHODS: Retrospectively 52 patients who underwent laparoscopic (n = 28) or open ureteroneocystostomy (n = 24) for lower ureteral stricture between January 2018and December 2021 were included. The demography, aetiology, radiologic imaging, intraoperative & postoperative outcomes and follow-up data were collected and analysed. RESULTS: The mean duration of follow up was 14.3 months. Lower ureteric stricture were common in females. The most common cause of the stricture was iatrogenic injury (42%). Other causes were tuberculosis, post-endourological surgery, obstructing mega ureter, endometriosis and idiopathic. Laparoscopic surgery had longer mean operative time (228 vs 171 min), less blood loss (166 vs 246 ml), lower VAS score (6.1 vs 7.22) and less need of post-operative analgesia (1.86 vs 2.36 days). The hospital stay (5.36 vs 6.77 days) and post-operative complications (none vs 3) were also significantly lower in laparoscopic group. Open surgery and laparoscopic surgery had success rate of 100% and 96.6% each. CONCLUSIONS: Iatrogenic injury are the most common cause of ureteric stricture followed by tuberculosis. Laparoscopic approach is a feasible option in treatment of lower ureteric stricture as it offer comparable outcome to open procedure while offering the advantage of a minimal invasive technique. Stricture secondary to iatrogenic injury poses a different challenge due to presence of hard dense fibrosis. This is a complex reconstructive procedure and has a steep learning curve and demands high level of laparoscopic skill.
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Laparoscopía , Tuberculosis , Uréter , Obstrucción Ureteral , Femenino , Humanos , Uréter/cirugía , Estudios Retrospectivos , Constricción Patológica , Centros de Atención Terciaria , Obstrucción Ureteral/cirugía , Laparoscopía/métodos , Enfermedad IatrogénicaRESUMEN
Localized ureteral amyloidosis is a rare disease clinically and radiographically similar to ureteral carcinoma. We reported a 56-year-old man with painless gross hematuria. CT and Magnetic resonance urography (MRU) examinations showed tumor signs and ureteral amyloidosis was diagnosed by ureteral biopsy. Laparoscopic partial ureterectomy combined with boari flap was performed and the patient's renal function was preserved. There was no local recurrence and distant metastasis during the 1-year follow-up.
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BACKGROUND: Ureteroscopy is well-established as a primary treatment modality for urolithiasis. Ureteral avulsion, particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope, is a rare but devastating complication of the procedure. Management of this complication is challenging. Moreover, general consensus regarding the optimal management is undetermined. We report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term results. CASE SUMMARY: A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital. A modified, extended Boari flap technique was successfully performed to repair the full-length ureteral defect. Maximal mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free anastomosis. Meticulous blood supply preservation to the flap also contributed to the success. During the 4-year study period, no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were reported. The patient was satisfied with the surgical outcomes. CONCLUSION: The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion, particularly in emergencies.
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A 63-year-old man underwent distal ureterectomy as a treatment for urothelial carcinoma of the ureter. Reconstruction of the urinary system was accomplished by tubularizing part of the bladder roof (Boari flap). A year later, metastatic evaluation with 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) showed high metabolic activity in the reconstructed area. Thorough evaluation confirmed the presence of a bladder diverticulum (the Boari flap) with no evidence of malignancy. We present the first 18 F-FDG PET/CT images of a Boari flap in the literature.
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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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Hidronefrosis , Laparoscopía , Uréter , Obstrucción Ureteral , Constricción Patológica/etiología , Constricción Patológica/cirugía , Humanos , Hidronefrosis/cirugía , Reimplantación/métodos , Uréter/lesiones , Uréter/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugíaRESUMEN
STUDY OBJECTIVE: To investigate the short-term outcomes of laparoscopic ureteroneocystostomy in patients with ureteral endometriosis (UE). DESIGN: Retrospective cohort study of consecutive patients who underwent surgery for the ureter endometriosis with hydronephrosis. SETTING: A private hospital that provide primary, secondary and tertiary care. PATIENTS: 30 consecutive patients with UE who underwent laparoscopic ureteroneocystostomy at our institution between May 2008 and April 2020. INTERVENTIONS: Laparoscopic ureteroneocystostomy, if necessary, hysterectomy, salpingo-oophorectomy, cystectomy, partial bladder resection, or partial bowel resection were performed. MEASUREMENTS AND MAIN RESULTS: The most common chief complaint was pelvic pain (40%). Endometriosis affected only the left ureter in 56.7% of patients, only the right ureter in 33.3%, and both ureters in 6.7%. Involvement of the ipsilateral ovary was confirmed in 64.3%. The most frequent location of UE was 1-3 cm above the UVJ (46.7%). A psoas hitch was performed in 7 patients (23.3%), and the Boari flap was used in 9 patients (30%). Hysterectomy was performed in 12 patients (40%), and 6 of them had a concomitant bilateral salpingo-oophorectomy (20%). In addition, 3 patients (10%) underwent partial bowel resection, and 2 patients (6.7%) underwent partial bladder resection. After surgery, 24 of 27 patients (80.0%) were free of sever hydronephrosis after surgery. Hydronephrosis recurred in a single patient (3.3%), but the grade of hydronephrosis improved significantly after surgery (P < 0.001). At 6 months of follow up, 4 patients (13.3%) experienced urinary tract infections and 2 patients (6.7%) reported dysuria. Patients reported a regression of dysmenorrhea symptoms (P < 0.001). CONCLUSION: This study shows that ureteroneocystostomy provides good results in terms of relapses and symptom control in patients with ureteral endometriosis.
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Endometriosis , Hidronefrosis , Laparoscopía , Uréter , Enfermedades Ureterales , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Humanos , Hidronefrosis/complicaciones , Hidronefrosis/cirugía , Laparoscopía/métodos , Recurrencia Local de Neoplasia/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Uréter/cirugía , Enfermedades Ureterales/complicaciones , Enfermedades Ureterales/cirugíaRESUMEN
Purpose: Although robot-assisted laparoscopic ureter reimplantation (RALUR) is a recognized alternative to open and laparoscopic ureter reimplantation in treating distal ureteral obstruction, there are limited data on long-term efficacy and safety outcomes of non-antireflux RALUR. We assessed patients undergoing RALUR, evaluating operative, functional, and safety determinants. Materials and Methods: All consecutive patients undergoing non-antireflux RALUR between April 2015 and January 2020 were included in this retrospective cohort study. The primary outcome endpoint was recurrent distal ureteral obstruction. Results: Mean follow-up was 41.3 months (95% confidence interval, 33.3-49.2; range 2-82). Among the 26 included patients, none developed recurrent distal ureteral obstruction. Kidney function in terms of serum creatinine level (72.0 µmol/L vs 71.0 µmol/L, p = 0.988) and glomerular filtration rate (92.0 mL/min vs 91.0 mL/min, p = 0.831) was stable between the preoperative period and the last follow-up. Renal pelvis dilatation decreased significantly postoperatively, from grade 2 to grade 0 (p < 0.001). Most patients (73.1%) remained free from any clinical symptoms of reflux during the follow-up. No recurring urinary tract infections were reported. The rate of postoperative complications (Clavien-Dindo grade ≥II) was 23.1%. All complications resolved without sequelae. Conclusions: Non-antireflux RALUR appears to be safe and effective in the management of distal ureteral obstruction. There was no recurrent ureteral obstruction after RALUR in our cohort during a mean follow-up of more than 3 years. Non-antireflux reimplantation did not seem to have any notable impact on renal function during the follow-up period.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Uréter , Obstrucción Ureteral , Reflujo Vesicoureteral , Humanos , Reimplantación , Estudios Retrospectivos , Resultado del Tratamiento , Uréter/cirugía , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/cirugía , Reflujo Vesicoureteral/cirugíaRESUMEN
Following failed retrograde and antegrade ureteric stenting, a 35-year-old male patient underwent an elective boari flap for marked proximal hydroureteronephrosis due to a periureteric mass in the right iliac fossa. Intraoperative vascular surgical assistance was required for control of arterial bleeding due to friable vessel wall. Histopathology demonstrated desmoid fibromatosis.
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Background: Aim of this study was to report a single-center experience with robot-assisted ureteral reimplantation (RAUR) and to compare its outcomes with those of open ureteral reimplantation (OUR). Materials and Methods: Patients who underwent RAUR or OUR for ureteral disease between 2016 and 2020 were identified. Data collected included baseline, pathologic, perioperative, and postoperative features. The RAUR outcomes were compared with those of OUR. Results: Overall, 21 (42.8%) patients underwent RAUR, and 28 (57.2%) underwent OUR. The two groups were similar in terms of baseline and pathologic characteristics. There was a statistically significant difference in favor of RAUR for median operative time (216 vs 317 minutes, p = 0.01) and median blood loss (35 vs 175 mL, p = 0.001). No difference was observed in overall complication rate (33.3% vs 46.4%, p = 0.9), as well as major complications (Clavien-Dindo≥III grade) rate between RAUR and OUR groups. Median length of stay was shorter for RAUR (2 vs 6 days; p = 0.001), as well as median catheterization time (16 vs 28 days; p = 0.005). Conclusions: RAUR is a safe and effective minimally invasive surgical procedure for the management of mid to distal ureteral strictures. It can recapitulate the success rate of the gold standard OUR while offering a benefit in terms of lower surgical morbidity and faster postoperative recovery.
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Laparoscopía , Robótica , Uréter , Obstrucción Ureteral , Humanos , Reimplantación , Resultado del Tratamiento , Uréter/cirugía , Obstrucción Ureteral/cirugíaRESUMEN
OBJECTIVE: To describe step-by-step surgical techniques and report outcomes of the largest single-centre series of patients with distal ureteric disease exclusively treated with robot-assisted ureteric reimplantation with Boari flap (RABFUR) and psoas hitch (RAPHUR), with a minimum follow-up of 1 year and complete postoperative data. PATIENTS AND METHODS: A total of 37 patients with distal ureteric disease were treated between 2010 and 2018. Of these, 81% and 19% underwent RAPHUR and RABFUR, respectively. Intra-, peri- and postoperative outcomes were assessed. The 90-day postoperative complications were reported according to the standardised methodology proposed by the European Association of Urology Ad Hoc Panel. Functional outcomes (creatinine, estimated glomerular filtration rate [eGFR]) and postoperative symptoms (visual analogue pain scale) were assessed. RESULTS: The median operating time and blood loss were 180 min and 100 mL, respectively. There were no conversions to open surgery and no intraoperative transfusions. The median length of stay, bladder catheter indwelling time and stent removal were 4, 7 and 30 days, respectively. The median follow-up was 24 months. Overall, 10 patients (27%) had postoperative complications and of these, eight (22%) and two (5.4%) were Clavien-Dindo Grade I-II and III, respectively. At the last follow-up, the median postoperative creatinine level and eGFR were 0.9 mg/dL and 73.5 mL/min/1.73 m2 , respectively. At the last follow-up, five (13.5%) and three (8%) patients had Grade 1 hydronephrosis and mild urinary symptoms, respectively. The study limitations include its retrospective nature. CONCLUSION: In the present study, we present our RABFUR and RAPHUR techniques. We confirm the feasibility and safety profile of both approaches in patients with distal ureteric disease relying on the largest single-centre series with ≥1 year of follow-up.
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Reimplantación/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Colgajos Quirúrgicos , Uréter/cirugía , Enfermedades Ureterales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica , Catéteres de Permanencia , Creatinina/sangre , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Hidronefrosis/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/etiología , Músculos Psoas , Reimplantación/efectos adversos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Colgajos Quirúrgicos/efectos adversos , Factores de Tiempo , Enfermedades Ureterales/fisiopatología , Catéteres Urinarios , Adulto JovenRESUMEN
INTRODUCTION: The problem of impaired urodynamics of the lower urinary tract after reconstructive surgery of the pelvic ureter remains almost unexplored in modern literature. There are only a few publications about the effect of operations in the area of the ureterovesical segment on bladder function. AIM: To study the function of bladder after replacing the pelvic ureter with bladder flap, small intestine or appendix. MATERIALS AND METHODS: We performed a retrospective analysis of reconstructive operations of the distal ureter, which were performed in 273 patients. Boari flap or its modifications were used in 142 (52%) cases; ureteroappendicocystanastomosis - 23 (8.4%) patients, and replacement of the pelvic ureter with small intestine in 105 (38.5%) cases. A follow-up urodynamics was carried out on the 10-14th day of the postoperative period, after 3 months, then after 6 and 12 months. We evaluated: uroflowmetry, cystometry, and pressureflow study. RESULTS: In 75 (53%) of 142 patients who underwent Boari flap or its modifications, varying degrees of disturbance of bladder urodynamics were observed. After isoperistaltic intestinal ureteroplasty in 2 (2.5%) of 79 patients, detrusor hyperactivity was observed, which was regressed following conservative therapy. Urodynamics of bladder did not suffer after appendicoplasty. CONCLUSION: Deformation, denervation and devascularization of detrusor are the main causes of bladder dysfunction after flap operations. Ileal ureter substitution with isoperistaltic position of the graft provides physiological passage urine from the kidney to the bladder, following good bladder function. The inclusion of antiperistaltic ileal loop in the urinary tract negatively affects the urodynamics.
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Uréter , Humanos , Estudios Retrospectivos , Vejiga Urinaria , Urodinámica , Procedimientos Quirúrgicos UrológicosRESUMEN
Introduction: Ureteral reimplantation is indicated for patients with congenital distal ureteral strictures, for iatrogenic intraoperative distal ureteral injuries, and for those who require distal ureterectomy for transitional cell carcinoma. Methods: Using the da Vinci system from Intuitive, we demonstrate distal ureterectomy with reimplantation. Both a refluxing extravesical reimplant and nonrefluxing extravesical reimplant are shown. We also demonstrate modifications, including psoas hitch and Boari flap. Results: Robotic ureteral reimplantation with psoas hitch and Boari flap are demonstrated in a reproducible manner. Additional topics covered include the delineation of diseased ureter vs healthy ureter, the applications of indocyanine green, and the use of interoperative ureteral stents. Conclusions: Robotic ureteral reimplantation is safe and feasible when performed with proper technique. Ureteroscopy and near-infrared fluorescence technology facilitate improved detection of diseased ureteral segments. Key points include the maintenance of principles of open surgery such as a tension-free, watertight, and stented anastomosis.
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Uréter , Obstrucción Ureteral , Humanos , Reimplantación , Colgajos Quirúrgicos , Uréter/cirugía , Procedimientos Quirúrgicos UrológicosRESUMEN
Reconstruction of the ureter is still regarded as a sophisticated approach demanding absolute dedication of the urologists. Similarly, iatrogenic ureteral injuries, as well as strictures, are quite common complexities of the pelvic and gynecological surgeries which if left untreated could lead to short as well as long-term issues. Presently, a case of a post-caesarian section along with hysterectomy of 40 years old woman has been presented that has resulted in distal left ureteral injury. A bilateral Boari flap was performed for the mobilization of the bladder.
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OBJECTIVE: To demonstrate techniques of laparoscopic ureteral reconstruction for long-segment ureteral defects in gynecologic surgeries. DESIGN: Step-by-step demonstration of a laparoscopic ureteral reimplantation using the Boari flap and ileal interposition. SETTING: Gynecologic diseases often involve the ureter; hence, knowledge of ureteral reconstruction techniques is imperative in gynecologic surgeries. The important aspect of ureteral reconstruction is to ensure tension-free anastomosis; therefore, various methods are required depending on the length of the ureteral defect [1]. The Boari flap and ileal interposition are preferred for repairing 8-cm to 12-cm and >12-cm ureteral defects, respectively. These methods have traditionally required large incisions [2,3]. Laparoscopic ureteral reimplantation using the Boari flap and ileal interposition has been reported to be as safe as the open technique and superior in terms of postoperative recovery in urologic surgeries [3,4]; however, to the best of our knowledge, it has not been reported in the field of gynecology. To our knowledge, this is the first report to demonstrate the techniques of laparoscopic Boari flap and ileal ureter replacement in gynecologic surgeries. The technique was approved by our institutional review board. INTERVENTIONS: The first case involved an intra-abdominal desmoid tumor, whereas the second case involved recurrent endometrial cancer. In both cases, long-segment ureteral resection was required to achieve complete tumor clearance. Laparoscopic ureteral reimplantation was performed successfully, without any complications, using the Boari flap in the first case and ileal interposition in the second. CONCLUSION: Laparoscopic ureteral reimplantation is technically feasible for the management of long-segment ureteral defects.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Reimplantación/métodos , Uréter/cirugía , Anastomosis Quirúrgica/métodos , Femenino , Fibromatosis Agresiva/patología , Fibromatosis Agresiva/cirugía , Humanos , Íleon/patología , Íleon/cirugía , Japón , Laparoscopía/métodos , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/cirugía , Procedimientos de Cirugía Plástica/métodos , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Colgajos Quirúrgicos/cirugía , Uréter/patología , Neoplasias Ureterales/patología , Neoplasias Ureterales/cirugía , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Vagina/patología , Vagina/cirugíaRESUMEN
A 53-year-old female presented with left loin pain and imaging showed left pan-ureteral stricture secondary to tuberculosis. The renal unit was salvaged by percutaneous nephrostomy. She was planned for ileal ureteric replacement. An extended Boari flap was constructed for her as the bladder capacity was good and Boari bladder flap reached the renal pelvis without tension. Follow-up nephrostogram revealed wide pyelovesical junction with prompt drainage. She completed antituberculous treatment. Extended Boari flap is rarely used for upper ureteric reconstruction. It should be considered as an option for complete ureteric reconstruction in the unilateral pan-ureteral stricture in selected cases.
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The experience with robotic reconstructive surgery has been reported previously. Many studies have demonstrated that the use of robotic surgery for those procedures is safe and effective. However, the characteristics related to those cases, make reconstructive surgery a very complex procedure that is usually managed in some referral centers only. Indocyanin green (ICG) is a substance that could be visualized using near-infrared fluorescence (NIRF). This fluorescence could help the surgeon for orientation and evaluation of viability of the tissues. OBJECTIVE: This article describes the literature and our experience using ICG for reconstructive surgery of the ureter. METHODS: We describe the literature and our approach for the evaluation and treatment of the ureteral stricture using ICG. CONCLUSION: The use of ICG has demonstrate to be safe, easy to perform and reproducible. In this article, we showed the ICG usefulness for complex reconstructive cases. Prospective studies with long follow up and bigger simple will permit a better evaluation of its results.
La experiencia con la cirugía reconstructiva asistida por robot ha sido reportada previamente. Dichos estudios han demostrado que el uso del robot en este tipo de procedimientos es seguro y eficaz. Sin embargo, las características de este tipo de casos hacen que la cirugía reconstructiva sea altamente compleja y por ende realizada solo en algunos centros de referencia. La ausencia de tacto durante la cirugía robótica hace que el cirujano dependa de ciertas claves visuales para su orientación. La indocianina verde (ICV) es un tinte que puede ser visualizado usando fluorescencia cercana a la luz infrarroja (FCLI). Dicha fluorescencia puede ser utilizada tanto para la orientación del cirujano como para la evaluación de la viabilidad de tejidos.OBJETIVO: En este artículo describimos el uso reportado en la literatura y nuestra experiencia utilizando ICV en cirugía reconstructiva, principalmente ureteral.MÉTODOS: Describimos nuestro abordaje en la evaluación y tratamiento de pacientes con estrechez ureteral usando ICV. A la vez, hacemos una revisión de los estudios previos realizados sobre este tema.CONCLUSIÓN: El uso de ICV ha demostrado ser seguro, fácil de realizar y repetir. La literatura y nuestra experiencia demuestra su utilidad en casos reconstructivos complejos. Estudios prospectivos a largo plazo y mayor escala permitirán evaluar mejor estos resultados.