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Boari Flap Ureteral Reconstruction

Reconstruction of long distal ureteral defects using a tubularized bladder flap (Boari flap) anastomosed to the proximal ureter, often combined with psoas hitch, for bridging gaps that exceed primary reimplantation length.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Boari Flap Ureteral Reconstruction?

The Boari flap is a U-shaped, full-thickness bladder flap raised from the anterior bladder wall and tubularized to extend proximally and reach a divided ureter when the gap exceeds the length achievable by direct ureteroneocystostomy or psoas hitch alone.

Indications include iatrogenic ureteral injuries, gynecologic or oncologic resections, radiation injury, ureteral strictures, and selected ureteral tumors after segmental resection.

The procedure can be performed open, laparoscopically, or robotically and is typically combined with psoas hitch and antireflux tunneling for protection of the upper urinary tract.

Symptoms

Ureteral injury identified intraoperatively during pelvic or retroperitoneal surgery
Postoperative urinary leak, urinoma, or ureteral fistula
Distal ureteral stricture causing obstruction and hydronephrosis
Ureteral tumor requiring segmental resection with reconstruction
Failed previous primary repair or ureteroneocystostomy

Risk Factors

Prior pelvic surgery, pelvic radiation, or extensive endometriosis
Locally advanced gynecologic, colorectal, or urologic malignancy
Bladder capacity less than 200 mL or significant bladder fibrosis
Active urinary tract infection at time of surgery
Inadequate bladder mobility precluding flap creation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Postoperative flank pain and creatinine rise after pelvic surgery
  • Persistent urinary drainage from a wound or vagina
  • Hydronephrosis with distal ureteral stricture longer than 3 cm
  • Recurrent strictures despite endourologic treatment

Treatment Methods

01
Preoperative imaging — CT urography and antegrade or retrograde pyelography to define the defect
02
Cystoscopy with bladder capacity assessment and treatment of infection prior to surgery
03
Construction of a 4 to 5 cm wide tubularized anterior bladder flap with psoas hitch and antireflux submucosal tunnel
04
Indwelling double-J stent for 4 to 6 weeks and bladder catheter for 7 to 14 days
05
Postoperative renal ultrasound at 4 to 6 weeks and at 6 months to confirm patency and exclude reflux

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.