Boari-Flap/Psoas Hitch Ureteric Reimplantation
What is Boari-Flap/Psoas Hitch Ureteric Reimplantation?
Boari-flap/psoas hitch ureteric reimplantation is a reconstructive surgical procedure used to repair or bypass damage to the lower or middle section of the ureter, the tube that carries urine from the kidney to the bladder. When a segment of the ureter is diseased, scarred, injured, or removed, the remaining healthy ureter may not be long enough to reach the bladder. In such cases, the surgeon creates a flap from the bladder (Boari flap) and, if necessary, secures the bladder to the psoas muscle (psoas hitch) to bridge the gap. This restores the normal flow of urine while preserving kidney function. The procedure may be performed through open, laparoscopic, or robotic-assisted techniques, depending on the patient's condition and the surgeon's expertise.
What are the Benefits of Boari-Flap/Psoas Hitch Ureteric Reimplantation?
This procedure offers several important advantages for suitable patients, including:
- Restores normal urine drainage from the kidney to the bladder.
- Preserves kidney function by relieving urinary obstruction.
- Avoids the need for more extensive urinary reconstruction in many cases.
- Uses the patient's own bladder tissue for reconstruction.
- Provides a durable, long-term solution for ureteric defects.
- Reduces the risk of recurrent urinary infections caused by obstruction.
- Can be performed using minimally invasive techniques in appropriate patients, resulting in smaller incisions and faster recovery.
When is Boari-Flap/Psoas Hitch Ureteric Reimplantation Recommended?
- Ureteric injury during pelvic or abdominal surgery.
- Narrowing (stricture) of the lower or middle ureter.
- Removal of a ureteric tumour requiring reconstruction.
- Damage caused by previous radiation therapy.
- Traumatic injury affecting the ureter.
- Recurrent ureteric obstruction that cannot be treated with simpler procedures.
- Congenital abnormalities affecting the lower ureter in selected patients.
Your urologist may recommend this procedure in the following situations:
What does preparation for Boari-Flap/Psoas Hitch Ureteric Reimplantation involve?
Preparation begins with a thorough medical assessment, including blood tests, urine analysis, and imaging studies such as CT urography or retrograde pyelography to evaluate the extent of ureteric damage. The surgeon reviews the patient's medical history, medications, and any allergies. Certain blood-thinning medications may need to be temporarily stopped under medical supervision. Active urinary tract infections are treated before surgery. Patients are usually advised to avoid eating or drinking for several hours before the operation and receive detailed instructions regarding hospital admission, anaesthesia, and postoperative expectations.
How is Boari-Flap/Psoas Hitch Ureteric Reimplantation performed?
The procedure is carried out under general anaesthesia. After accessing the surgical area, the damaged portion of the ureter is removed while preserving healthy tissue. If additional length is required, the bladder is gently mobilised and attached to the psoas muscle, a technique known as a psoas hitch. A rectangular flap is then created from the bladder wall, shaped into a tube, and connected to the healthy end of the ureter to form a new passage for urine. A temporary ureteric stent is placed across the repair to support healing and maintain urine flow. The bladder is closed carefully, and a urinary catheter is inserted to allow continuous drainage during the initial healing period. The operation may be performed using open, laparoscopic, or robotic-assisted methods, depending on the complexity of the reconstruction.
What to Expect during Recovery after Boari-Flap/Psoas Hitch Ureteric Reimplantation?
Most patients remain in hospital for several days following surgery. Pain is managed with medication, and the urinary catheter usually remains in place for one to two weeks. The ureteric stent is typically removed several weeks later during a follow-up appointment. Patients are encouraged to walk soon after surgery but should avoid heavy lifting and strenuous activities for several weeks. Follow-up imaging may be performed to confirm successful healing and normal urine drainage. Most individuals gradually return to normal activities as recovery progresses.
What are the Risks and Complications of Boari-Flap/Psoas Hitch Ureteric Reimplantation?
Although generally safe, the procedure carries some potential risks, including:
- Bleeding during or after surgery
- Infection of the wound or urinary tract
- Leakage of urine from the repair site
- Recurrent ureteric narrowing or obstruction
- Injury to nearby organs or blood vessels
- Temporary bladder irritation or urinary symptoms
- Risks associated with general anaesthesia
- Rare need for additional procedures if healing is incomplete