Robotic appendiceal onlay flap ureteroplasty combined with Boari flap-psoas hitch ureteroneocystostomy for repair of the 20 cm ureteral avulsion: initial experience and case report.

Ureteral avulsion is a rare but serious complication of ureteroscopic lithotomy. As a common treatment for long segment ureteral avulsion, ileal ureteral replacement has many complications, such as anastomotic site stricture and retrograde infection, and prolonged exposure of the intestinal mucosa to urine may result in postoperative metabolic acidosis. Autologous tissue is becoming increasingly popular in ureteroplasty, including oral mucosa, appendix and bladder. Recent advancements in ureteral reconstruction techniques have highlighted the utility of the appendix and bladder, but the length of autologous tissue is limited. In order to reduce complications and save autologous tissue, we propose a novel combined technique. This study aims to evaluate the feasibility and outcomes of appendiceal onlay flap ureteroplasty combined with Boari flap-psoas hitch ureteroneocystostomy in the treatment of long segment ureteral avulsion, with a 15-month follow-up. We report a 64-year-old male patient diagnosed with right ureteral avulsion. In this case, the ureteral reconstruction was accomplished through our new technique. Antegrade urography revealed no obstruction of the reconstructed ureteral segment at 7 weeks after surgery. After a 15-month follow-up period, no postoperative complications occurred, radiological resolution of hydronephrosis and improved renal function were observed. Our initial experience demonstrated that appendiceal onlay flap ureteroplasty combined with Boari flap-psoas hitch ureteroneocystostomy is safe and feasible. This novel surgical method provides a promising option for treating long segment ureteral avulsion.