Boari Flap Reconstruction
Bladder Based Repair for Distal Ureteral Defects
Boari flap reconstruction is performed to repair defects or injuries involving the lower portion of the ureter, the tube that drains urine from the kidney to the bladder. When this segment of the ureter is damaged, scarred, or removed, urine flow can become blocked and threaten kidney function. When the missing segment is too long for a simple reimplantation, the Boari flap can bridge the gap using native bladder tissue.
What Problem Does This Surgery Treat?
Boari flap reconstruction is performed to repair defects or injuries involving the lower portion of the ureter, the tube that drains urine from the kidney to the bladder. When this segment of the ureter is damaged, scarred, or removed, urine flow can become blocked, threatening kidney function.
Common causes include previous pelvic or ureteral surgery, injury during gynecologic or colorectal procedures, radiation therapy, urinary stones, or long term infection. In some cases, the missing or diseased segment is too long to be corrected by a simple reimplantation of the ureter into the bladder. In those situations, the Boari flap technique offers a practical option to bridge the gap and restore urinary continuity.
What Is a Boari Flap?
A Boari flap uses a section of the patient’s own bladder wall to create a tube that extends upward to meet the shortened ureter. The flap is shaped, lifted, and folded into a narrow channel, which then serves as a new connection between the bladder and ureter.
This approach is chosen when the ureteral defect cannot be closed directly and when the bladder has sufficient size and mobility to reach the area of injury. Compared to other reconstructive techniques, such as using an intestinal segment, the Boari flap keeps the urinary tract entirely within native tissue, reducing metabolic complications.
When Is Boari Flap Reconstruction Recommended?
This procedure is recommended for:
- Defects or strictures involving the lower or middle ureter, typically up to 10–15 centimeters in length
- Cases where blood supply to the distal ureter has been compromised
- Revision surgeries after unsuccessful prior repairs
- Selected instances following trauma, stone disease, or surgical injury
The decision to perform a Boari flap depends on the location and length of the defect, the condition of the bladder, and the patient’s overall health.
How Is the Boari Flap Reconstruction Performed?
The surgery is performed under general anesthesia. Depending on individual factors, it can be done through an open, laparoscopic, or robotic assisted approach.
The bladder is first mobilized to allow it to reach higher in the pelvis. A flap is then outlined on the bladder wall, raised, and shaped into a tube. This new tubular segment is connected to the healthy end of the ureter. A temporary internal stent is placed to keep the connection open while healing occurs.
At the end of the operation, a urinary catheter is left in place to allow the bladder to rest and drain properly during the initial recovery period.
What to Expect After Surgery
Patients usually remain in the hospital for several days for monitoring, pain control, and early recovery. The urinary catheter typically remains in place for one to two weeks. The internal stent is normally left for four to six weeks to support healing and is removed during a follow up procedure.
Follow up imaging or ultrasound is performed to confirm normal urine drainage before the stent is removed. Most patients can resume normal daily activity gradually over a few weeks after discharge.
Risks and Possible Complications
As with all surgery, complications can include bleeding, infection, or delayed healing. Risks specific to this procedure may include:
- Urine leakage from the repair site
- Narrowing (stricture) at the new junction
- Recurrent ureteral obstruction
- Reduced bladder capacity or frequency changes
- Temporary discomfort from the stent or catheter
Although uncommon, these issues may require additional evaluation or corrective treatment.
Results and Long Term Outlook
Most patients experience restoration of normal urine flow and preservation of kidney function after successful Boari flap reconstruction. Long term outcomes are generally favorable when the repair heals well and the underlying problem is fully addressed.
Ongoing follow up is important to monitor kidney performance and ensure there is no recurrence of obstruction or scarring over time.
When to Seek Urgent Care
Contact your surgical team or go to an emergency department if you experience:
- Fever, chills, or signs of infection
- Persistent or heavy bleeding in the urine
- Sudden flank or abdominal pain
- Swelling or redness at the incision site
- Inability to urinate after catheter or stent removal
Prompt medical review helps prevent complications and ensures proper healing.
Disclaimer
This information provides a general overview of Boari Flap Reconstruction. It is not a substitute for medical advice, diagnosis, or treatment. Your individual care plan may differ. Always follow the recommendations of your treating clinician.