Laparoscopic bladder flap ureteral reimplantation: Survival porcine study

Purpose: The bladder or Boari flap is a useful technique for ureteroneocyst ostomy when the distal ureter is too short to reach the bladder without und ue tension. We report our experience with laparoscopic Boari flap ureterone ocystostomy in the chronic porcine model. Materials and Methods: Six female farm pigs underwent unilateral laparoscop ic Boari bladder flap ureteroneocystostomy. Refluxing direct ureteral reimp lantation was performed in the initial 3 animals. In the next 3 animals a s ubmucosal tunnel was formed to achieve nonrefluxing ureteroneocystostomy in to the Boari flap. The animals were sacrificed 6 weeks after surgery. At sa crifice ascending cystography, ipsilateral antegrade pyelography and autops y examination of the ureteroneocystostomy site was performed. Results: No intraoperative or postoperative complications were noted. Avera ge operative time was 140 minutes. Postoperatively serum creatinine and hem oglobin were normal in all pigs. All 3 animals with direct ureteroneocystos tomy into the Boari flap had free reflux into the kidney and all 3 with a s ubmucosal tunnel reimplant had no reflux on ascending cystography and free drainage on antegrade pyelography. Autopsy confirmed a patent anastomotic s ite in all 6 cases. Conclusions: Laparoscopic ureteroneocystostomy using the Boari bladder flap technique is feasible. Our survival porcine model confirms the successful application of the refluxing and nonrefluxing technique of ureteral reimpla ntation. Clinical application of the technique has the potential to decreas e patient morbidity associated with traditional open surgery.