Open Boari Flap Ureteroneocystostomy in a Radiated Pelvis: A Durable Solution for Complex Distal Ureteric Strictures

Ureteric injury and subsequent stricture formation following pelvic surgery and radiotherapy for cervical cancer represent a challenging urological complication. The Boari flap technique offers a reliable reconstructive option for bridging long ureteric defects when ureteroneocystostomy alone is insufficient. We report a rare case of successful open Boari flap ureteric reimplantation in an elderly patient who had undergone abdominal hysterectomy and pelvic radiation for carcinoma cervix. A 70-year-old female with a background of carcinoma of the cervix, treated with total abdominal hysterectomy followed by adjuvant external beam pelvic radiotherapy, presented with a 6-month history of right flank pain, recurrent urinary tract infections, and progressive hydroureteronephrosis. Computed tomography urogram and retrograde pyelography confirmed a long-segment distal left ureteric stricture measuring approximately 7 cm just proximal to the vesicoureteric junction secondary to radiation-induced fibrosis. She underwent open Boari flap ureteric reimplantation with psoas hitch augmentation. The intraoperative and postoperative courses were uneventful. At 12-month follow-up, renal function was preserved, and radiological imaging confirmed a patent, nonobstructed upper urinary tract. Open Boari flap ureteric reimplantation remains a viable and effective reconstructive procedure for complex distal ureteric strictures in postradiation, posthysterectomy patients. Careful patient selection, meticulous surgical planning, and close postoperative surveillance are essential to optimize outcomes in this high-risk population.