The Boari Bladder Flap: A simple, effective continent catheterizable stoma technique for the neurogenic bladder.

Back to 77th Annual Meeting
Back to Program Outline

Background: A continent catheterizable stoma is commonly used to facilitate bladder emptying in the neurogenic bladder population. The purpose of this study was to evaluate the use of a retroperitoneal Boari bladder flap (BBF) for continent catheterizable stoma creation.
Methods: Patients treated with BBF were identified through retrospective review of surgical logs. IRB approved chart review was performed for demographic, urodynamic, operative, post operative data. Safety was assessed through review of intraoperative and post operative complications. Efficacy was assessed by review of post operative continence per stoma or urethra and renal function. All patients underwent BBF via a standardized technique: An infraumbilical midline incision was utilized to access the retroperitoneal space. The bladder was filled to capacity and detrusor muscle at the bladder dome was exposed. A trapezoid flap measuring 10cm in length, 5 to 6 cm wide at the base, and 2 cm at the tip was marked and created off the lateral-posterior bladder wall. When performed on a patient with a previous enterocystoplasty, the flap did not cross any suture lines. The flap was tubularized over a 12 or 14 Fr red rubber catheter using a 2 layer closure with absorbable suture. The detrusor was plicated around the base of the stoma tube to create a flap valve. The stoma was then brought out through the umbilicus or lower abdomen. After surgery, the catheter was left in place 3 weeks. Patients began catheterizing every 4 hrs.
Results: Eight patients (4 female, 4 male) treated with BBF were identified. Median age was 42.2 yrs (range 28.4-55.3). Neurogenic bladder was attributed to spinal cord injury (n=3), myelodysplasia (n=2), cerebral palsy (n=1), epispadias (n=1) and bladder extrophy (=1). No patient could void spontaneously and all patients utilized an indwelling urethral catheter for bladder drainage prior to surgery. Clean intermittent catheterization could not be performed per urethra due to body habitus/loss of manual dexterity (6/8) or urethral compromise (2/8). Prior to BBF, median bladder compliance on urodynamics was 43.9 ml/cm/H2O (range 20.5-433). All bladders were insensate and none demonstrated urodynamic detrusor overactivity. Median operative time was 195 min (range 140-260min) and EBL was 100ml (range 50-600ml). No intraoperative complications were noted. Mean length of stay after surgery 7 days (5-9d). Over a median follow up of 3.2 months (range 0.6-12.6), no patients reported incontinence per stoma and renal function remained stable. Post operative complications included incontinence per urethra (1 patient), stomal stenosis (2), and traumatic disruption of stoma during catherterization (1). No postoperative urinary tract infections or change in renal function were recorded.
Conclusions: Boari catheterizable stoma is a safe and effective method of continent urinary diversion in selected patients.

Back to 77th Annual Meeting
Back to Program Outline