Robot assisted ureteral reimplantation with neobladder Boari flap
Abstract
We report a robot-assisted Boari-flap ureteral reimplantation in a 58yr old patient who previously underwent a robotic radical cystectomy and intracorporeal orthotropic ileal neobladder. A 9-mo post-operative CT scan showed a 3 cm stricture of left distal ureter with concomitant grade III hydronephrosis, treated with percutaneous nephrostomy.
Patient position and port placement were similar to Robotic radical cystectomy. The neobladder and a thin left distal ureter were easily identified. The ureter was identified and sharply dissected before ending in a fibrotic tissue. The ureter was spatulated and passed through the mesosigma.
Neobladder was opened and a Boari flap prepared.
A direct refluxing reimplantation was performed on a double J stent. The neobladder was closed with running sutures and irrigated to confirm water tightness.
A drain was left in place.
Perioperative course was uneventful; no urine leakage occurred; patient was discharged on third post-operative day. Double-j stent was removed after 3 weeks. A 6-mo renal function assessment and a 1-yr postoperative CT-scan showed normal eGFR values and relief of ureteral obstruction.
Robot-assisted ureteral reimplantation in orthotropic neobladder is a safe, feasible and minimally invasive procedure. Neobladder Boari flap is viable option to overcome ureter shortness.