Robot-assisted Boari flap and psoas hitch ureteric reimplantation: technique insight and outcomes of a case series with ≥1 year of follow-up

BJU Int. 2021 Nov;128(5):625-633. doi: 10.1111/bju.15421. Epub 2021 May 5.

Abstract

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.

Keywords: #EndoUrology; #Urology; Boari flap; outcomes; psoas hitch; robot-assisted surgery; ureteric reimplantation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Loss, Surgical
  • Catheters, Indwelling
  • Creatinine / blood
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Hydronephrosis / etiology
  • Length of Stay
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Complications / etiology
  • Psoas Muscles
  • Replantation / adverse effects
  • Replantation / methods*
  • Retrospective Studies
  • Robotic Surgical Procedures / adverse effects
  • Robotic Surgical Procedures / methods*
  • Surgical Flaps* / adverse effects
  • Time Factors
  • Ureter / surgery*
  • Ureteral Diseases / physiopathology
  • Ureteral Diseases / surgery*
  • Urinary Catheters
  • Young Adult

Substances

  • Creatinine