Letters

210 Urology Journal    Vol 5    No 3    Summer 2008

Re: Laparoscopic Distal Ureterectomy and Boari 
Flap Ureteroneocystostomy for a Low-Grade Distal 
Ureteral Tumor

Sir,
The article by Basiri and coworkers details their 
experience with a patient with low-grade ureteral 
cancer on whom they performed laparoscopic 
distal ureterectomy with a subsequent 
reconstruction using the Boari flap.(1)  
The present article helps to add evidence 
regarding feasibility and safety (technical 
and functional) of pure laparoscopic partial 
ureterectomy. Although it is evident that open 
nephroureterectomy has been standardized and 
can, to date, guarantee acceptable perioperative 
morbidity, allowing reproducible long-term 
oncologic results for ureteral cancer, it appears 
from their experience that when the candidates 
for surgery are appropriately selected and there is 
a dedicated surgical team for laparoscopy, these 
goals are achievable. Roupret and colleagues 
retrospectively reviewed 6 patients with low-
grade upper urinary tract transitional cell 
carcinoma treated laparoscopically, concluding 
that laparoscopic distal ureterectomy with re-
implantation is technically possible for low-risk 
low-grade upper urinary tract transitional cell 
carcinoma.(2) At this point, the exact role of 
laparoscopic partial ureterectomy is still under 
careful evaluation, as data from the literature are 
limited, especially regarding important issues 
such as long-term results and the feasibility of 
urinary reconstruction, which remains technically 

challenging.(3) Their report is noteworthy since 
they give us information about subsequent 
laparoscopic Boari flap, detailing important 
surgical steps. Apparently, initial goal will be to 
provide the same outcome as in a standard open 
procedure with the hope that in the future, as we 
gain more experience, learning curve will provide 
an improvement in terms of less blood loss and a 
decrease in length of hospital stay. 

Teruo Inamoto
Haruhito Azuma
Yoji Katsuoka

Department of Urology, Osaka Medical 
College, Osaka, Japan

E-mail: tinamoto@poh.osaka-med.ac.jp

REFERENCES
1. Basiri A, Karami H, Mehrabi S, Javaherforooshzadeh. 

Laparoscopic distal ureterectomy and Boari flap 
ureteroneocystostomy for a low-grade distal ureteral 
tumor. Urol J. 2008;5:120-2.

2. Roupret M, Harmon JD, Sanderson KM, et al. 
Laparoscopic distal ureterectomy and anastomosis 
for management of low-risk upper urinary tract 
transitional cell carcinoma: preliminary results. BJU 
Int. 2007;99:623-7.

3. Uberoi J, Harnisch B, Sethi AS, Babayan RK, Wang 
DS. Robot-assisted laparoscopic distal ureterectomy 
and ureteral reimplantation with psoas hitch. J 
Endourol. 2007;21:368-73.