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...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.展开更多
文摘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.
