Endopyelotomy associated ureteral necrosis: complete ureteral replacement using the Boari flap

A case of an adolescent who sustained necrosis of the entire ureter after attempted endopyelotomy for congenital ureteropelvic junction obstruction is presented. Successful reconstruction of a neoureter was performed easily with the Boari bladder flap coupled with nephropexy and a psoas hitch. Although repair of upper ureteral injuries with the Boari flap has been described in the literature, to our knowledge its use in the pediatric population has not. Our case exemplifies how the Boari flap repair is particularly suitable in children for bridging significant segments of injured ureters, not just the lower third.