Zhong MZ, Huang WN, Huang GX, Zhang EP, Gan L. Long-term results of extended Boari flap technique for management of complete ureteral avulsion: A case report. World J Clin Cases 2022; 10(34): 12610-12616 [PMID: 36579100 DOI: 10.12998/wjcc.v10.i34.12610]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2022; 10(34): 12610-12616 Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12610
Long-term results of extended Boari flap technique for management of complete ureteral avulsion: A case report
Ming-Zhu Zhong, Wei-Na Huang, Gui-Xiao Huang, En-Pu Zhang, Lu Gan
Ming-Zhu Zhong, Wei-Na Huang, Department of Urology, Shenzhen Baoan Shiyan People's Hospital, Shenzhen 518108, Guangdong Province, China
Gui-Xiao Huang, En-Pu Zhang, Lu Gan, Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518005, Guangdong Province, China
Author contributions: Zhong MZ designed and drafted the manuscript; Huang WN contributed to manuscript revision; Huang GX, Zhang EP, and Gan L collected the clinical data; Zhong MZ, Huang GX, Zhang EP, and Gan L discussed management options for and provided medical care to the patient; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: June 9, 2022 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
Abstract
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.
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.
