Ureteral substitution with a stapled neoureter: A simplified Boari flap

Purpose: We evaluate a new technique that will quickly and easily replace a long segment of ureter by creating a tapered neoureter (Boari flap) with b ladder wall and absorbable staples. Materials and Methods: A neoureter was created in 14 pigs with native bladd er and 75 mm. Polysorb gastrointestinal anastomosis staplers (U. S. Surgica l, Norwalk, Connecticut). Urine culture and serum creatinine were obtained before neoureter creation. Neoureter length and time to construct were reco rded. At 6 weeks serum creatinine was repeated, and ureteral stent removed with evaluation of the staple lines for stones and residual staples. At 4 m onths intravenous pyelogram, cystogram and serum creatinine were obtained b efore necropsy. The bladder, neoureter and kidneys were examined grossly an d histologically for hydronephrosis, staples, stones and stenosis. Results: Mean neoureter length was 13.4 cm. and mean time to construct was 15 minutes. Laboratory results were unremarkable. Of the 14 pigs 2 died of pneumonia before stent removal, and at autopsy neither had evidence of hydr onephrosis nor anastomotic stricture. In the remaining 12 pigs there was no evidence of residual staples or stone formation with mucosa covering the s taple line at cystoscopy and necropsy. Successful neoureter substitution wa s performed in 9 pigs with no gross or histological changes. There were 3 p igs that had evidence of hydronephrosis with histological findings of chron ic pyelonephritis and 2 of them appeared atrophic compared to the contralat eral. kidney. Conclusions: Our study demonstrates a new technique for ureteral substituti on with bladder and absorbable staples that may be performed quickly and ea sily. Furthermore, we show that absorbable staples can be safely incorporat ed into the urinary tract with minimal worry about encrustation or calculus formation.