Indications for combined psoas-bladder hitch procedure with Boari vesical flap

Area of Science:

• Urology
• Surgical Technique

Background:

• Ureteral injuries, particularly in the pelvic region, pose significant surgical challenges.
• Existing methods for ureteral reconstruction have limitations in addressing mid-ureteral defects.

Purpose of the Study:

• To describe a combined surgical approach for repairing injuries to the middle third of the ureter.
• To evaluate the feasibility of using a modified Boari flap for ureteral reimplantation.

Main Methods:

• The study details a combined technique involving the psoas-bladder hitch procedure and the Boari vesical flap.
• Key steps include mobilizing and extraperitonealizing the bladder to create a tunneled flap.
• The technique emphasizes fashioning a specific bladder flap from the anterior bladder wall.

Main Results:

• The combined approach facilitates repair of middle third ureteral injuries.
• It provides improved access for reimplantation of the proximal ureter.
• Successful creation of a longer Boari flap is possible with adherence to the described technique.

Conclusions:

• The combination of psoas-bladder hitch and Boari flap offers a viable solution for mid-ureteral defects.
• This technique enhances reconstructive possibilities for ureteral injuries.
• Careful bladder flap construction is crucial for optimal outcomes.