title: Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction.
abstract: OBJECTIVE
  We defined the role of the Boari bladder flap procedure with or without downward nephropexy for proximal vs distal ureteral strictures.
  
  
  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%, p = 0.060), hospital stay was longer (mean 8.0 vs 4.4 days, p = 0.017) and mean estimated blood loss was greater (447 vs 224 ml, p = 0.008).
  
  
  CONCLUSIONS
  The Boari bladder flap procedure is a reliable technique to reconstruct ureteral strictures regardless of site. Renal mobilization with downward nephropexy is a useful adjunctive maneuver for proximal strictures.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Mauck
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hudak
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Terlecki
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods