Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12610
Peer-review started: June 9, 2022
First decision: July 29, 2022
Revised: August 15, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: December 6, 2022
Processing time: 176 Days and 11.9 Hours
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.
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 anas
The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion, particularly in emergencies.
Core Tip: Management of complete ureteral avulsion caused by ureteroscopy is challenging. In the presented case, a modified, extended Boari flap technique was successfully performed to repair the full-length ureteral defect. 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. This manuscript suggests the importance of the extended Boari flap procedure as a feasible and favorable treatment option to manage complete ureteral avulsion; moreover, ileal ureteral substitution or renal autotransplantation may be reserved as the second choice.