THE RESULTS OF THE BOARI-FLAP PROCEDURE IN LOWER URETERAL SUBSTITUTION

Introduction: Various techniques such as ureteroneocystostomy, Boari-flap and ileal ureter are generally used in repair of lower ureteral loss. In this study, we reviewed the results of Boari-flap procedure in repair of lower ureteral loss caused by various pathologies.

Materials and Methods: The charts of 10 patients underwent Boari-flap procedure between 1991 and 2002 at our institution were reviewed.

Results: Total 10 patients (male: 3, female: 7) aged between 27 and 47 years (mean: 38.7 years) had undergone Boari-flap procedure at our clinic in a -10- year period. Indications of operation were as follow: In 6 patients, ureterovaginal fistulas secondary to gynecological surgery, in 2 patients rigid ureteroscopic interventions, in 1 patient urinary tuberculosis and in 1 patient penetrating trauma caused by gunshot wound. All patients had undergone Boari-flap procedure which was originally described. All ureteric reimplantations were made with an antireflux submucosal tunnel procedure. Mean neoureter length was 9.2 cm (7-14 cm), and in only 2 patients psoas hitch procedure was required. In all cases double-J catheter were used a ureteral stent. Urethral catheter and double-J stents were removed 7th and 21st after operation, respectively. Neither vesicoureteral reflux nor ureteral stricture was observed in all patient in a -26- month follow up period (12-42 months).

As a result, Boari-flap procedure should be first choice in repair of long lower ureteral loss because it can be applied easily and its results are perfect.