Ureterolysis and Boari Flap

Ureterolysis is the release of the ureter from its surrounding compressive fibrotic tissue. It is required in the setting of extrinsic compression from retroperitoneal disease processes, including idiopathic retroperitoneal fibrosis, lymphoma, infection, or scarring from previous surgery. Boari flap ureteral reimplantation is a reconstructive procedure utilized in the management of mid and distal ureteral strictures when a segment of ureter is unhealthy and too long for tension-free ureteroureterostomy and/or a psoas hitch does not allow for a tension-free ureteroneocystostomy. With the advances in robotic surgical technology, urologic surgeons have demonstrated both safety and efficacy comparable to that of open surgery with all the advantages of minimally invasive surgery. In this chapter, the authors describe the disease workup, operative setup, and surgical techniques, including strategies for identifying the ureter and troubleshooting tips for anticipated intraoperative complications, robotic ureterolysis, and Boari flap ureteral reimplantation.