Robotic Totally Intracorporeal Bilateral Boari Flap Reconstruction for Complex Bilateral Ureteral Strictures: A...

Boari flap reconstruction is effective for unilateral ureteral strictures (1-5), but its use for bilateral disease is rarely reported. Robotic surgery offers enhanced visualization and dexterity for complex ureteral reconstruction (4, 6-9). We describe robotic totally intracorporeal bilateral Boari flap (BBF) reconstruction for bilateral mid- and distal ureteral strictures (BMDUS).

A 42-year-old woman with BMDUS underwent BBF reconstruction. The left ureter was dissected, ligated, and transected proximal to the stricture, then trimmed to healthy tissue until a 10-Fr catheter passed smoothly; the same steps were repeated on the right. After measuring each ureteral defect, bilateral inverted U-shaped bladder flaps were tailored and hitched to the ipsilateral psoas tendons. A double-J stent was placed in each ureter. The healthy proximal ureters were anastomosed to the corresponding flaps, and both flaps were tubularized with running sutures. The bladder was then closed and a drain was placed.

The procedure was completed successfully without conversion to open surgery. Operative time was 263 minutes, estimated blood loss was 55 mL, and bilateral 6-cm Boari flaps were created. The urinary catheter, double-J stents, and nephrostomy tubes were removed at 7 days, 5 weeks, and 6 weeks, respectively. At 12 months, bladder capacity was 352 mL, post-void residual volume was 8 mL, maximum flow rate was 26 mL/s, and eGFR had increased from 36.0 to 50.6 mL/min/1.73 m². At 35 months, the patient remained symptom-free with no late complications.

Robotic totally intracorporeal BBF reconstruction is technically feasible. Larger studies with long-term follow-up are warranted. Funding This research received funding support from the National Natural Science Foundation of China (82470724) and Zhongnan Hospital of Wuhan University (grant no. rcyj20230102 to Bing Li).