Urine normally flows from the kidneys through tubes called ureters and into the urinary bladder, where it is stored until the urge to urinate. Injury to the ureters may causes reflux of urine back into the kidneys. Ureteral reconstruction is a surgery performed to re-connect the ureters at the correct place in the bladder to avoid reflux of urine and reduce any obstruction in the ureter.
A Boari bladder flap is a best option for ureteric reimplantation when the diseased or unhealthy ureteric segment is long (e.g. more than 5 cm). It is useful in the management of lower ureteric strictures and can be performed as either an open or laparoscopic procedure. It may involve tubularisation of the flap of bladder to expand from the bladder to the ureteral orifice.
The Boari’s flap procedure is performed under general anesthesia. Doctor makes a small incision in your lower abdomen midline and then your ureter and bladder are exposed.
The injured section of the ureter is excised. A flap of bladder tissue was incised or cut and rolled over the ureter to form a tube, and is sutured.
The base of the flap is sutured to the bladder. Doctor may put a ureteral stent (thin tube) inside the ureter to decrease urological complications.
The incisions are then sutured closed.
Boari’s flap surgery may be related with certain complications such as recurrent narrowing of the ureter due to tension at the surgical connection and improvement of pseudodiverticulum (a protuberance of the inner layers of the ureter tissues). There are alternate minimally invasive/laparoscopic procedures that can be availed of. The open Boari’s flap surgery is restricted to chosen cases only.