Complete transplant ureteral reconstruction: a modification of the Boari flap

Total loss of a transplanted renal allograft ureter from long or multisegment ureteral strictures or ischemic necrosis represents a formidable challenge to the reconstructive surgeon. Direct reimplantation is often not possible due to insufficient length of undamaged ureter or in cases where the native ureter is abnormal, short, nonfunctional, or absent. Using the bladder for reconstruction via Boari flap circumvents these problems and permits successful restoration of the urinary tract. The psoas minor muscle is the classic landmark used for fixation of the bladder after mobilization. Often after renal transplantation, the psoas muscle is not accessible due to position and orientation of the allografted kidney. We present our experience with a modified Boari bladder flap for complete transplant ureteral reconstruction using the fibrotic plate of the demucosalized allograft ureter as the structure used to hitch the recipient bladder.