Boari Flap

If the ureteral defect necessitates mobilization of the bladder above the level of the pelvic brim, then a Boari flap can be performed.8 This procedure is also particularly useful when dealing with a long mid ureteral stricture/ injury where a primary anastomosis may not be possible. This technique was first described by Boari in 1894 and involves constructing a bladder flap based on the ipsilat-eral superior vesical artery posteriorly and connecting the tubularized flap to the ureter (Figure 13-4.1). The length of flap should be equal to the defect plus a few centimeters. The contralateral superior vesical artery can also be divided for more length. The flap is brought up to the ureter and anastomosed. Fine absorbable suture is used and, again, a stent and drain should be placed. This procedure should not be attempted when the bladder is small or contracted because there will be insufficient remaining bladder capacity and postoperative voiding dysfunction will be significant.

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