Robotic Totally Intracorporeal Bilateral Boari Flap Reconstruction for Complex Bilateral Ureteral Strictures: A Step-by-Step Technique.
Shuaishuai Chai, Yuancheng Zhou, Junwei Hu et al.
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Case in brief
A 42-year-old woman with complex bilateral mid- and distal ureteral strictures underwent robotic, totally intracorporeal bilateral Boari flap reconstruction. Healthy proximal ureters were joined to tailored bladder flaps, with a double-J stent placed on each side. The operation was completed without conversion to open surgery; bilateral 6-cm flaps were created. At 12 months, bladder capacity was 352 mL, post-void residual was 8 mL, maximum flow rate was 26 mL/s, and eGFR had risen from 36.0 to 50.6 mL/min/1.73 m². At 35 months, she remained symptom-free without late complications.
What made this case unusual
The report demonstrates bilateral use of a totally intracorporeal robotic Boari flap for mid- and distal ureteral strictures, an application the authors describe as rarely reported.
Diagnostic / clinical pearl
For selected bilateral mid- and distal ureteral strictures, robotic intracorporeal bilateral Boari flap reconstruction was technically feasible in this case, with symptom-free follow-up reported at 35 months.
Why it matters
The authors note that larger studies with long-term follow-up are needed to better characterize this reconstructive approach.