Radtke Jan P, Korzeniewski Nina, Huber Johannes, Alt Celine D, Pahernik Sascha, Hadaschik Boris A, Hohenfellner Markus, Teber Dogu
Department of Urology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
Langenbecks Arch Surg. 2017 Dec;402(8):1271-1278. doi: 10.1007/s00423-017-1554-0. Epub 2017 Jan 16.
The study aims to describe the technique and analyze the outcome of an arcuated bladder incision with building of a triangular flap, first described by Uebelhoer (UBBF), as a modification of the classical rectangular Boari bladder flap (BBF), that is often viable, but can present difficulties, such as reduced flap vascularization and mobility in pretreated patients.
Twelve consecutive patients with distal or mid ureteral leakage or stenosis, that underwent UBBF, were retrospectively analyzed. We assessed postoperative morbidity using Clavien-Dindo classification. Short- and long-term functional outcomes were assessed using glomerular filtration rate (GFR), ultrasound, and renal scintigraphy.
Patients underwent UBBF during initial oncological surgery in five cases and due to ureteral defects following oncological surgery or radiotherapy in seven cases. Median patient age was 57 (interquartile range (IQR) 46-72), defect length was 7.5 cm (IQR 5-8 cm), and median follow-up period was 41 (IQR 36-48) months. In short-term follow-up, 11/13 postoperative morbidities were Clavien-Dindo level I-II complications, mostly infections. Two level IIIa complications occurred. One anastomotic leakage was treated sufficiently with temporarily ureteral stenting and one voiding disorder needed intervention. In the long-term follow-up, 84% of patients had improved or constant GFR. In the one-year renal scintigraphy, no urodynamically relevant voiding disorder occurred.
The UBBF is a reliable procedure to reconstruct ureteral trauma even in complex oncological, pretreated patients suffering from distal or mid ureteral defects. It can be performed easily by a modified arcuate incision and provides good long-term functional outcomes.
本研究旨在描述一种弧形膀胱切口并构建三角形皮瓣的技术（最初由Uebelhoer描述，即UBBF），作为经典矩形Boari膀胱皮瓣（BBF）的改良方法。BBF通常可行，但在经过预处理的患者中可能存在困难，如皮瓣血管化减少和活动度降低。
对连续12例行UBBF的远端或中段输尿管漏或狭窄患者进行回顾性分析。我们使用Clavien-Dindo分类评估术后发病率。使用肾小球滤过率（GFR）、超声和肾闪烁显像评估短期和长期功能结果。
5例患者在初次肿瘤手术期间行UBBF，7例患者因肿瘤手术或放疗后输尿管缺损而行UBBF。患者中位年龄为57岁（四分位间距（IQR）46 - 72岁），缺损长度为7.5 cm（IQR 5 - 8 cm），中位随访期为41个月（IQR 36 - 48个月）。在短期随访中，13例术后并发症中有11例为Clavien-Dindo I-II级并发症，主要为感染。发生了2例IIIa级并发症。1例吻合口漏通过临时输尿管支架置入得到充分治疗，1例排尿障碍需要干预。在长期随访中，84%的患者GFR改善或稳定。在1年的肾闪烁显像中，未发生与尿动力学相关的排尿障碍。
即使在患有远端或中段输尿管缺损的复杂肿瘤预处理患者中，UBBF也是重建输尿管创伤的可靠方法。它可以通过改良的弧形切口轻松完成，并提供良好的长期功能结果。
