Case Report: Re-do Boari flap for recurrent ureteric stricture

Abstract Boari flap is reliable techniques to reconstruct ureteral strictures regardless of their site with most common reported complication of the procedure being recurrent stricture formation. We report a case of 33 year old female patient who was managed with initial Boari flap for iatrogenic ureteric during the third caesarean section for intra-operative diagnosis of placenta percreta which adherent all the way to the bladder mucosa. The patient was managed initially with ultrasound guided Right percutaneous nephrostomy tube insertion on third post-operative day based on ultrasound study which revealed Right moderate hydronephrosis. Right percutaneous nephrostomy tube was kept there for two months until the initial boari flap was performed. The patient presented with severe right side flank pain after the removal of the stent which was inserted during initial boari flap. The stent replaced and kept in situ for one year until the admission for re-do exploration. The stent was removed and computed tomography Urography was done revealing right distal ureteric narrowing with proximal hydronephrosis. During re-exploration the intra operative finding was short length tight stricture at anastomotic site of the ureter and Boari flap. The strictured segment respected and Re-do Boari flap over stent was performed. After one month post-operative, stent was removed and patient is symptom free at second month follow up with no hydronephrosis on ultrasound.