{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:51:51Z","timestamp":1759971111581,"version":"build-2065373602"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJUI Compass"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To present an alternative technique called pseudo\u2010flap for reconstructing long ureteral defects as an alternative to Boari flap. Despite being used for more than 70\u2009years by urologists for tension\u2010free reconstruction of distal and mid\u2010ureteral defects, the Boari flap exhibits high complication rates, with an average of 27% (range 5.5%\u201330.4%). These complications arise from compromised blood supply, attributed to incisions made on all three sides of the flap and dependence on the flap base as the sole source of blood supply.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed patients who underwent our modified technique by a single surgeon between 2008 and 2021. We used a semi\u2010oblique cystotomy on the lowest part of the anterior and contralateral aspects of the bladder after complete release from adhesions and sacrificing the superior vesical pedicle, if necessary. The innovative part of the technique involved making short relaxing incisions at different levels on both sides of a pseudo\u2010flap while pushing the bladder dome upward to reach the healthy ureter in a tension\u2010free manner, followed by anastomosis with a non\u2010refluxing or refluxing technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen patients underwent the pseudo\u2010flap technique with a mean follow\u2010up of 16.9\u00a0months. Four had prior radiation, three had hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis, and one had a ureteral stricture in a transplanted kidney. Eight procedures were performed during intraoperative consultations.<\/jats:p><jats:p>Only one patient (7%) developed a major complication (Clavien\u2013Dindo grade \u22652). This patient developed postoperative leak, and none developed obstructive hydronephrosis, suggesting stricture or flap ischemia. The mean length of the flap was 9.3\u00a0cm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our pseudo\u2010flap technique has lower complication rates than the traditional Boari flap. It is not technically challenging, minimally compromises blood supply and is thus especially suitable for complex, highly morbid patients with decreased tissue vascularity, such as those with prior radiation and peritoneal carcinomatosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bco2.327","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T02:32:01Z","timestamp":1708482721000},"page":"447-459","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Newly modified \u2018pseudo flap\u2019 without compromising vascularity to enhance repair of long distal ureteral loss: A retrospective analysis of a prospective database"],"prefix":"10.1002","volume":"5","author":[{"given":"Majid","family":"Mirzazadeh","sequence":"first","affiliation":[{"name":"Department of Urology, Wake Forest University School of Medicine Wake Forest Baptist Medical Center  Winston\u2010Salem North Carolina 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