Indiana University School of Medicine, Indianapolis, IN.
Department of Urology, Indiana University, Indianapolis, IN.
Urology. 2024 Apr;186:31-35. doi: 10.1016/j.urology.2024.01.020. Epub 2024 Feb 17.
To describe our institution's experience with Boari flap ureteral reconstruction, specifically focusing on the development of postoperative lower urinary tract symptoms (LUTS).
A retrospective review of all Boari flaps performed at our institution between 2013 and 2023 was performed, excluding patients with urothelial carcinoma and males, given the frequency of LUTS from benign prostatic hyperplasia. Primary outcome was the development of new onset LUTS and subsequent treatment. Secondary outcomes included postoperative infections and ureteral stricture.
Twenty-nine total patients were identified. Mean age was 52.2 years (standard deviation (SD) 13.1). Mean follow-up was 22.3 months (SD 25.3). Primary reasons for ureteral reconstruction were radiation damage (37.9%) and iatrogenic surgical injury (37.9%). A concurrent psoas hitch was performed in 18/29 (62%) cases, nephropexy was utilized in 1/29 (3.4%) cases, and contralateral bladder pedicles were ligated in 10/29 (34.5%) for increased bladder mobilization. Postoperatively, 8 patients (27.6%) developed new-onset LUTS, effectively managed with oral anticholinergics. Recurrent urinary tract infections occurred in 5 patients (17.2%) and pyelonephritis in 1 (3.4%) patient. Two patients (6.9%) developed ureteral strictures, one treated with ileal ureter replacement and the other with ureteral balloon dilation.
Boari bladder flap ureteral reconstruction leads to moderate rates of new onset LUTS postoperatively, which is important information when counseling women on reconstructive options. Boari flap ureteral reconstruction has a high success rate, and serious complications are rare. In the setting of ureteral injury, reconstruction using Boari flaps with or without psoas hitch should be considered for definitive management.
描述我们机构在 Boari 皮瓣输尿管重建方面的经验，特别关注术后下尿路症状 (LUTS) 的发展。
对 2013 年至 2023 年间在我们机构进行的所有 Boari 皮瓣手术进行回顾性分析，排除患有尿路上皮癌和男性患者，因为良性前列腺增生症会导致 LUTS 的发生率较高。主要结局是新发 LUTS 的发展和随后的治疗。次要结局包括术后感染和输尿管狭窄。
共确定了 29 名患者。平均年龄为 52.2 岁（标准差 (SD) 13.1）。平均随访时间为 22.3 个月（SD 25.3）。输尿管重建的主要原因是放射性损伤（37.9%）和医源性手术损伤（37.9%）。在 29 例患者中，18 例（62%）同时行腰大肌悬带固定术，1 例（3.4%）行肾固定术，10 例（34.5%）结扎对侧膀胱蒂以增加膀胱移动度。术后，8 名患者（27.6%）出现新发 LUTS，有效治疗方法是口服抗胆碱能药物。5 名患者（17.2%）发生复发性尿路感染，1 名患者（3.4%）发生肾盂肾炎。2 名患者（6.9%）发生输尿管狭窄，1 例患者接受回肠代输尿管治疗，另 1 例患者接受输尿管球囊扩张治疗。
Boari 膀胱皮瓣输尿管重建术后会导致中度新发 LUTS，这在为女性提供重建选择时是重要的信息。Boari 皮瓣输尿管重建术成功率高，严重并发症罕见。在输尿管损伤的情况下，应考虑使用 Boari 皮瓣联合或不联合腰大肌悬带固定术进行确定性治疗。
