Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction

Abstract

Purpose: We defined the role of the Boari bladder flap procedure with or without downward nephropexy for proximal vs distal ureteral strictures.Materials and Methods: We retrospectively reviewed the records of all patients who underwent open ureteral reconstruction for refractory ureteral strictures, as done by a single surgeon between 2007 and 2010. Patients were grouped by stricture site into group 1—proximal third of the ureter and group 2—distal two-thirds. Operative techniques and outcomes were reviewed.Results: During the 30-month study period a total of 29 ureteral reconstruction procedures were performed on 27 patients. A Boari bladder flap was used in 10 of the 12 patients (83%) in group 1 and 10 of the 17 (59%) in group 2. Concomitant downward nephropexy was done more commonly in group 1 (58% vs 12%, p = 0.014). At a mean followup of 11.4 months there was no difference in the overall failure rate between groups 1 and 2 (17% vs 12%). Complications developed more frequently in group 1 (75% vs 35%,...