Dr. med. Dirk Manski

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Ureteral Reimplantation: Psoas Hitch and Boari-Flap Techniques

Ureterocystoneostomy is the reimplantation of the ureter into the urinary bladder; distal and mid-ureteral defects can be bridged (combined with using bladder tissue) in the case of:


Surgical Technique of Ureteral Reimplantation to Bridge Ureteral Defects

Preoperative Patient Preparation

Surgical Approach

Suitable surgical approaches depend on the indication and previous surgery: lower midline incision, gibson incision or paramedian laparotomy are possible. First steps are the extraperitoneal mobilization of the bladder. As far as possible, the peritoneum is dissected of the bladder. Depending on previous operations, a transperitoneal approach is more realistic. The ureter is marked with a vessel loop after identification. Depending on the underlying disease, ligate the distal diseased ureter or choose distal ureteral resection. The proximal end of the diseased ureter should be without scar tissue; spatulate the end and insert a ureteral stent (MJ) fixed with a rapidly absorbable suture. Pay attention to the ureteral vascular supply during all steps.

Psoas Hitch Ureteral Reimplantation:

The Psoas Hitch technique can bridge up to 10 cm of defective ureter.

Psoas hitch ureteral reimplantation.
figure Psoas hitch ureteral reimplantation.

Boari Flap Ureteral Reimplantation:

The Boari flap technique can bridge up to 15 cm of defective ureter (depending on the capacity of the urinary bladder).

Boari flap ureteral reimplantation.
figure Boari flap ureteral reimplantation.


Insert a drain near the anastomosis. Exit the ureteral stent through a separate stab incision of bladder and skin.

Technical Modifications:

The Psoas hitch and the Boari flap procedure can be performed laparoscopically (robotic-assisted) in experienced hands.

Postoperative Care after Ureteral Reimplantation

General measures:

Early mobilization, thrombosis prophylaxis depending on age, laboratory tests (hemoglobin, creatinine), regular physical examination of the abdomen and incision wound.


Analgesics with a combination of NSAIDs and opioids.

Drains and Catheters:

Remove the pelvic drain if the daily drainage volume is well below 50 ml, ureteral splint after 5–7 days, and bladder catheter after 5–10 days. Removal (consider cystography) depends on the amount of bladder reconstruction.

Complications of Ureteral Reimplantation

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Hinman: Atlas Urologischer Operationen im Kindes- und Erwachsenenalter.

  Deutsche Version: Harnleiterreimplantation: Technik nach Leadbetter, Lich-Gregoir, Psoas hitch und Boari Lappen