Boari Flap reconstruction

Rate :
Loading player ... The player requires Flash Player plugin


Boari Flap  

For ureteric defects longer than 6–8 cm, which cannot be bridged by the psoas hitch technique, the Boari flap offers an option for a tension-free ureteric anastomosis. The ureter is exposed through an extraperitoneal approach in the same technique described for the psoas hitch technique. In a case of redo surgery, a transperitoneal approach may be preferable depending on the amount of scarring and fibrosis. After radiation therapy of the pelvis or after multiple previous operations, the ureter is easier identified at its crossing with the common iliac artery or higher, in a healthy area. The bladder is filled through the Foley catheter and maximum mobilisation of the bladder is performed, including division of the median umbilical ligament (urachus) and both medial umbilical ligaments (umbilical arteries). The classical rectangular Boari flap of about 3–4 cm in width is marked by stay sutures with its base at the posterior lateral bladder wall above the original ureteric orifice and its tip at the contralateral anterior bladder wall. In the Übelhör modification, the bladder is incised on the affected side slightly oblique and this incision is anteriorly and distally extended to the contralateral site. This results in a wide rhombic flap with a broad basis, which can be rotated to the psoas muscle.


For fixation of the bladder flap to the psoas
muscle, two to three 3/0 poly-p-dioxanone
monofilament absorbable sutures (e.g.
Monoplus® or PDS®) are placed preferentially
through the tendon of the psoas muscle. The
sutures must encompass the entire detrusor
muscle thickness without mucosa.The sutures

must not be tied at this stage of the operation


After creation of the submucosal tunnel an
Overholt clamp is inserted retrogradely into the
tunnel and the ureter is pulled on its stay suture
into the tunnel. Thereafter the fixation sutures to
the psoas muscle are tied. After bladder fixation,
the ureter should enter the Boari flap in a
straight course without kinking at the entrance.
The ureter is re-implanted into the bladder flap
using the same technique as for the psoas


Before closing the bladder, the ureteric stent is
passed through the anterior bladder wall and a
cystostomy catheter (e.g. 10 F pigtail) is placed
into the bladder, both of which are anchored to
the detrusor on the outside with fast-absorbing
suture. The bladder is closed in two layers. Firstly
the mucosa is closed with a 4/0 or 5/0
glyconate monofilament absorbable running
suture (e.g. Monosyn® or Monocryl®). The
detrusor is closed with another running 3/0 or
4/0 poly-p-dioxanone monofilament absorbable
suture (e.g. Monoplus®). A paravesical gravity
drain is placed in the vicinity of the anastomosis


Raimund Stein, Peter Rubenwolf, Christopher Ziesel, Mohamed M. Kamal* and
Joachim W. Thüroff*
Division of Paediatric Urology and *Department of Urology, University Medical Center, Johannes Gutenberg
University, Mainz, Germany



Comments : 17

  • Quam

    Professor   |     |  
      |   12/1/2020 3:10:26 PM
    Custom essay writing online best custom essay
  • Finckh

    Professor   |     |  
      |   11/6/2020 7:27:18 AM
    Treatment extends life only slightly but may relieve symptoms
    and improve quality of life. when can viagra go generic
  • Tramel

    Professor   |     |  
      |   11/21/2020 1:47:41 AM
    Buy discount viagra online sildenafil
  • Bormann

    Professor   |     |  
      |   9/28/2020 3:29:54 PM
    Thanks for a marvelous posting! I certainly enjoyed reading it, you happen to be a great author.I will be sure to bookmark your blog and definitely
    will come back in the future. I want to encourage you to continue your great work, have a nice day!
  • Dashwood

    Professor   |     |  
      |   12/2/2020 3:50:40 PM
    Essay writing services toronto write my essay services
  • Hargrave

    Professor   |     |  
      |   12/13/2020 10:07:32 AM
    What can i take to enhance cialis otc cialis
  • Town

    Professor   |     |  
      |   11/21/2020 4:04:16 PM
    Viagra for ladies how much is
    the generic viagra
  • Farleigh

    Professor   |     |  
      |   12/11/2020 3:41:20 PM
    Viagra online order cialis
  • Daws

    Professor   |     |  
      |   12/13/2020 12:15:52 PM
    Buy real viagra online natural viagra
  • Ulm

    Professor   |     |  
      |   12/22/2020 8:06:33 AM
    Aw, this was an extremely nice post. Taking the time and actual effort to produce a great article…
    but what can I say… I procrastinate a lot and never seem to get
    anything done.
  • Nevile

    Professor   |     |  
      |   12/2/2020 7:21:03 PM
    Help me write an essay help with
    writing essays
  • Gholson

    Professor   |     |  
      |   12/13/2020 11:35:51 AM
    Buy viagra viagra for men
  • Grover

    Professor   |     |  
      |   10/30/2020 3:48:31 PM
    Get high and higher each drug sells, Forcing more slaves
    into the game. what is viagra
  • Boreham

    Professor   |     |  
      |   12/11/2020 11:38:13 PM
    Cheap tadalafil generic viagra
  • Casey

    Professor   |     |  
      |   12/1/2020 6:56:40 PM
    Essays online to buy buy essays online reviews
  • Reichert

    Professor   |     |  
      |   12/11/2020 4:23:26 PM
    Cialis dosage how long for cialis to work
  • Southwick

    Professor   |     |  
      |   12/5/2020 3:04:34 PM
    I need help writing a thesis thesis proposal example
  • Leave message

    Your rating:
    Security code