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

Case Report: Re-do Boari flap for recurrent ureteric stricture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Case Report: Re-do Boari flap for recurrent ureteric stricture Sewunet Muluneh, Bedri kazali, Tsion Nigussie, Admasu Melaku, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6590013/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version 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. Placenta percreta recurrent ureteric stricture Re-do Boari flap Ureteric injury Hydronephrosis Figures Figure 1 Figure 2 Background Iatrogenic ureter injury most commonly occurs during gynaecologic surgery with abdominal hysterectomy being the most common cause of injury with a potentially devastating complication.1 The Boari bladder flap procedure is a reliable technique to reconstruct ureteral strictures regardless of site with most common reported complication of the procedure being recurrent stricture formation. 2,3 Re-do Boari flap for recurrent ureteric stricture after prior Boari flap is one urologist’s surgical options with good outcome even if the procedure less commonly reported. 5 Boari-flap ureteral re-implantation as a sort of urinary bladder reconstruction permits restoration of the urinary tract and allows for successful kidney transplantation salvage for patient with post-transplant ureteral stenosis.6 Herein, we present a case, where re-do Boari flap reconstruction was performed to manage recurrent ureteric strictures after initial boari flap. To our knowledge, there are few description of re-do Boari flap in literature as mode of ureteric stricture repair. Case Presentation We report a case of 33 year old female patient who was managed with Boari flap for iatrogenic ureteric and Re-do Boari flap was done again after 1 year of initial boari flap for stricture of initial boari flap. The patient underwent 3rd caesarean section for indication of previous caesarean section with intra-operative diagnosis of placenta percreta which was adherent all the way to the bladder mucosa. As the patient was torrentially bleeding it was compelling to do partial hysterectomy and mass ligation was done to control the bleeding to salvage the patient. On 3rd post-operative day ultrasound study revealed Right moderate hydronephrosis for which ultrasound guided Right PCN placed and kept there for two and half months at which ante grade pyelogram was done .The ante grade pyelogram showed contrast passing up to level of pelvic brim but it does not enter bladder. (Figure1) After two and half month of initial hysterectomy patient was prepared and exploration done with intra operative finding of though inflammatory adhesion between lower abdominal wall, urinary bladder and appendix with loculated abscess pocket with suture ligation of right ureter .At this time appendectomy, bladder debridement and boar flap repair of right ureter over DJ stent which was removed after six weeks of surgery. After removal of DJ stent patient was having right flank pain which was relieved by reinsertion of DJ stent and subsequently patient has twice DJ stent exchange as she was having flank when stent is removed. After one year of initial boari flap repair CT urography was done and it showed right moderate hydrouteronephrosis with cortical enhancement with contrast and with dilated ureter with distal abrupt tapering. (Figure 2) At this time exploration was decided and patient explored through previous pfannestein incision with intra operative finding of extensive adhesion between lower abdominal wall and urinary bladder with one centimetre stricture at site previous anastomosis between boari flap and ureter with dilated proximal ureter. At this time strictured segment was resected and re-anastomosis between ureter and boari flap was done over DJ stent and pelvic drain was kept. POSTOPERATIVE COURSE At first post-operative day patient started sips, pelvic drain removed on second post-operative day and patient was discharge home on fourth post-operative day. At fourteenth post-operative day patient was seen at referral clinic and transurethral catheter remove and the patient has no compliant with clean surgical scar. At one month post-operative, stent was removed and patient is symptom free at second post-operative month with normal abdominal ultrasound and she is appointed to come with abdominal ultrasound at third post-operative month. Discussion The options available to treat a large ureteric defect are transureteroureterostomy, psoas hitch, Boari flap, ileal segment replacement for the lost ureter and renal auto transplantation. Boari flap is a reliable technique to reconstruct ureteral defect regardless of their site. Renal mobilization with downward nephropexy is a useful adjunctive maneuver for proximal strictures when boari flap is used for proximal ureteric stricture (3). The most common complication is clearly recurrent stricture formation, resulting from either ischemia or excessive tension on the anastomosis (2). The number of reported patients treated with a Boari flap is not significant, yet the results are excellent if a well vascularized, tension-free flap is used especially there is very scarce literatures on use of re-do boari flap for failed previous ureteric stricture repair (5,6). Despite technical difficulties in dissecting and exposing the previously boari flap site due to extensive adhesion between lower abdominal wall and urinary bladder and taking into consideration the patient’s relatively normal bladder volume, re-do Boari flap was performed, using an open approach: the healthy ureter was transacted above the stenotic segment at the level of the previous flap. The ureter was re-implanted to a newly formed Boari flap, which was harvested again from the bladder wall. This technique of re-do Boari flap for recurrent Boari flap anastomotic stricture, without the use of a bowel segment or augmentation, hence avoids both long term and short complications associated with bowel use. Conclusion Re-do Boari flap for recurrent ureteric stricture after prior Boari flap is one urologist’s surgical options with good short term outcome but studies with large volume patient with longer duration of follow up is recommend it as alternative procedure for patients with recurrent ureteric stricture after initial boari flap repair. Abbreviations CTU-computed tomography urography DJ stent-double J stent PCN-percutaneous Nephrostomy Declarations Consent The patient was informed about publication of her case and she has agreed for publication and she gave informed consent for publication. Ethical approval This study is exempt for ethical approval in our institution since it does not involve experimental treatment. COMPETING INTEREST The authors declare no conflict of interest. Funding There is no specific funding for this article received from agencies like public, commercial or not-for-profit organizations. Author's Contributions 1= Author and participated in patient management 2=Editor and participated in patient management 3=Editor and participated in patient management 4=participated in patient management 5=participated in patient management 6=participated in patient management Author's information 1=MD, general surgeon and urological surgery fellow at Addis Ababa university college of health science department of surgery urology unit 2= MD, general surgeon and assistant professor of urological surgery at Addis Ababa university college of health science department of surgery urology unit 3=MD, assistant professor of urological surgery at Addis Ababa university college of health science department of surgery urology unit 4=MD, urological surgery resident at Addis Ababa university college of health science department of surgery urology unit 5=MD, urological surgery resident at Addis Ababa university college of health science department of surgery urology unit 6=MD, general surgeon and urological surgery fellow at Addis Ababa university college of health science department of surgery urology unit References St Lezin MA, Stoller ML: Surgical ureteral injuries, Urology 38(6):497–506, 1991.Steers WD, Corriere JN, Benson GS, et al: The use of indwelling ureteral stents in managing ureteral injuries due to external violence, J Trauma 25(10):1001–1003, 1985. Berzeg S, Baumgart E, Beyersdorff D, Lenk S, Kopka L. Late complication of Boari bladder flap. Eur Radiol. 2003 Jul;13(7):1604-7. doi: 10.1007/s00330-002-1599-4. Epub 2002 Sep 10. PMID: 12835973. Mauck RJ, Hudak SJ, Terlecki RP, Morey AF. Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol. 2011 Oct;186(4):1345-9. doi: 10.1016/j.juro.2011.05.086. PMID: 21855904. Pearson BS. Experiences with the Boari flap. Br J Urol. 1970 Dec;42(6):740. PMID: 5491930. Sionov BV, Taha T, Preter D, Salbaq RA, Engelstein D, Tsivian A. Re-do Boari flap for recurrent ureteric stricture. Int Braz J Urol. 2021 May-Jun;47(3):670-673. doi: 10.1590/S1677-5538.IBJU.2020.0491. PMID: 33621021; PMCID: PMC7993970. S. ALSAADI; H. Toussi; M. Alseiari; M. Al Ahmed; M. Zaman. POS-749 Boari flap Ureteric Re-implantation, a Salvage Procedure for Kidney Transplant Ureteral Stenosis. Kidney International Reports, ISSN: 2468-0249, Vol: 7, Issue: 2, Page: S324 Publication Year2022. http://www.sciencedirect.com/science/article/pii/S2468024922007859; http://dx.doi.org/10.1016/j.ekir.2022.01.785; https://linkinghub.elsevier.com/retrieve/pii/S2468024922007859; https://dx.doi.org/10.1016/j.ekir.2022.01.785 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6590013","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":459476296,"identity":"5e90aedf-9e64-49c9-9bd7-01edf44a47b8","order_by":0,"name":"Sewunet 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passage of contrast into the bladder before initial boari flap\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6590013/v1/690112c44a30335e8bd91dab.png"},{"id":90897020,"identity":"c2800d6c-c628-4aa9-a438-343b3c6f517f","added_by":"auto","created_at":"2025-09-09 11:39:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":3361417,"visible":true,"origin":"","legend":"\u003cp\u003eCT urography before re-do boari flap demonstrating right moderate hydrouteronephrosis with cortical enhancement with contrast on axial image (A)and coronal image (B) with dilated ureter and distal abrupt tapering on coronal image (C) with blue arrow demonstrating site of taper.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6590013/v1/4f246eed878fceb9ffb3413d.png"},{"id":90897636,"identity":"725d434b-931c-4a71-8c52-1ac94b6b3cb9","added_by":"auto","created_at":"2025-09-09 11:46:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5101961,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6590013/v1/021664a8-c568-4697-8551-d64c64fc6bd2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case Report: Re-do Boari flap for recurrent ureteric stricture","fulltext":[{"header":"Background","content":"\u003cp\u003eIatrogenic ureter injury most commonly occurs during gynaecologic surgery with abdominal hysterectomy being the most common cause of injury with a potentially devastating complication.1 The Boari bladder flap procedure is a reliable technique to reconstruct ureteral strictures regardless of site with most common reported complication of the procedure being recurrent stricture formation. 2,3 Re-do Boari flap for recurrent ureteric stricture after prior Boari flap is one urologist’s surgical options with good outcome even if the procedure less commonly reported. 5 Boari-flap ureteral re-implantation as a sort of urinary bladder reconstruction permits restoration of the urinary tract and allows for successful kidney transplantation salvage for patient with post-transplant ureteral stenosis.6\u003c/p\u003e\n\u003cp\u003eHerein, we present a case, where re-do Boari flap reconstruction was performed to manage recurrent ureteric strictures after initial boari flap. To our knowledge, there are few description of re-do Boari flap in literature as mode of ureteric stricture repair.\u003c/p\u003e\n\n\n\n\n\n"},{"header":"Case Presentation","content":"\u003cp\u003eWe report a case of 33 year old female patient who was managed with Boari flap for iatrogenic ureteric and Re-do Boari flap was done again after 1 year of initial boari flap for stricture of initial boari flap.\u003c/p\u003e\u003cp\u003eThe patient underwent 3rd caesarean section for indication of previous caesarean section with intra-operative diagnosis of placenta percreta which was adherent all the way to the bladder mucosa. As the patient was torrentially bleeding it was compelling to do partial hysterectomy and mass ligation was done to control the bleeding to salvage the patient. On 3rd post-operative day ultrasound study revealed Right moderate hydronephrosis for which ultrasound guided Right PCN placed and kept there for two and half months at which ante grade pyelogram was done .The ante grade pyelogram showed contrast passing up to level of pelvic brim but it does not enter bladder. (Figure1) \u003c/p\u003e\u003cp\u003eAfter two and half month of initial hysterectomy patient was prepared and exploration done with intra operative finding of though inflammatory adhesion between lower abdominal wall, urinary bladder and appendix with loculated abscess pocket with suture ligation of right ureter .At this time appendectomy, bladder debridement and boar flap repair of right ureter over DJ stent which was removed after six weeks of surgery.\u003c/p\u003e\u003cp\u003eAfter removal of DJ stent patient was having right flank pain which was relieved by reinsertion of DJ stent and subsequently patient has twice DJ stent exchange as she was having flank when stent is removed. After one year of initial boari flap repair CT urography was done and it showed right moderate hydrouteronephrosis with cortical enhancement with contrast and with dilated ureter with distal abrupt tapering. (Figure 2)\u003c/p\u003e\u003cp\u003eAt this time exploration was decided and patient explored through previous pfannestein incision with intra operative finding of extensive adhesion between lower abdominal wall and urinary bladder with one centimetre stricture at site previous anastomosis between boari flap and ureter with dilated proximal ureter. At this time strictured segment was resected and re-anastomosis between ureter and boari flap was done over DJ stent and pelvic drain was kept.\u003c/p\u003e\u003cp\u003ePOSTOPERATIVE COURSE\u003c/p\u003e\n\u003cp\u003eAt first post-operative day patient started sips, pelvic drain removed on second post-operative day and patient was discharge home on fourth post-operative day. At fourteenth post-operative day patient was seen at referral clinic and transurethral catheter remove and the patient has no compliant with clean surgical scar. At one month post-operative, stent was removed and patient is symptom free at second post-operative month with normal abdominal ultrasound and she is appointed to come with abdominal ultrasound at third post-operative month.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe options available to treat a large ureteric defect are transureteroureterostomy, psoas hitch, Boari flap, ileal segment replacement for the lost ureter and renal auto transplantation. Boari flap is a reliable technique to reconstruct ureteral defect regardless of their site. Renal mobilization with downward nephropexy is a useful adjunctive maneuver for proximal strictures when boari flap is used for proximal ureteric stricture (3). The most common complication is clearly recurrent stricture formation, resulting from either ischemia or excessive tension on the anastomosis (2).\u003c/p\u003e\n\u003cp\u003eThe number of reported patients treated with a Boari flap is not significant, yet the results are excellent if a well vascularized, tension-free flap is used especially there is very scarce literatures on use of re-do boari flap for failed previous ureteric stricture repair (5,6). \u003c/p\u003e\n\u003cp\u003eDespite technical difficulties in dissecting and exposing the previously boari flap site due to extensive adhesion between lower abdominal wall and urinary bladder and taking into consideration the patient\u0026rsquo;s relatively normal bladder volume, re-do Boari flap was performed, using an open approach: the healthy ureter was transacted above the stenotic segment at the level of the previous flap. The ureter was re-implanted to a newly formed Boari flap, which was harvested again from the bladder wall.\u003c/p\u003e\n\u003cp\u003eThis technique of re-do Boari flap for recurrent Boari flap anastomotic stricture, without the use of a bowel segment or augmentation, hence avoids both long term and short complications associated with bowel use.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRe-do Boari flap for recurrent ureteric stricture after prior Boari flap is one urologist\u0026rsquo;s surgical options with good short term outcome but studies with large volume patient with longer duration of follow up is recommend it as alternative procedure for patients with recurrent ureteric stricture after initial boari flap repair. \u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003cp\u003eCTU-computed tomography urography\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDJ stent-double J stent\u003c/p\u003e\n\u003cp\u003ePCN-percutaneous Nephrostomy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConsent \u003c/p\u003e\n\u003cp\u003eThe patient was informed about publication of her case and she has agreed for publication and she gave informed consent for publication. \u003c/p\u003e\n\u003cp\u003eEthical approval \u003c/p\u003e\n\u003cp\u003eThis study is exempt for ethical approval in our institution since it does not involve experimental treatment. \u003c/p\u003e\n\u003cp\u003eCOMPETING INTEREST\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding \u003c/p\u003e\n\u003cp\u003eThere is no specific funding for this article received from agencies like public, commercial or not-for-profit organizations.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026apos;s Contributions \u003c/p\u003e\n\u003cp\u003e1= Author and participated in patient management \u003c/p\u003e\n\u003cp\u003e2=Editor and participated in patient management \u003c/p\u003e\n\u003cp\u003e3=Editor and participated in patient management \u003c/p\u003e\n\u003cp\u003e4=participated in patient management \u003c/p\u003e\n\u003cp\u003e5=participated in patient management \u003c/p\u003e\n\u003cp\u003e6=participated in patient management \u003c/p\u003e\n\u003cp\u003eAuthor\u0026apos;s information \u003c/p\u003e\n\u003cp\u003e1=MD, general surgeon and urological surgery fellow at Addis Ababa university college of health science department of surgery urology unit\u003c/p\u003e\n\u003cp\u003e2= MD, general surgeon and assistant professor of urological surgery at Addis Ababa university college of health science department of surgery urology unit \u003c/p\u003e\n\u003cp\u003e3=MD, assistant professor of urological surgery at Addis Ababa university college of health science department of surgery urology unit \u003c/p\u003e\n\u003cp\u003e4=MD, urological surgery resident at Addis Ababa university college of health science department of surgery urology unit \u003c/p\u003e\n\u003cp\u003e5=MD, urological surgery resident at Addis Ababa university college of health science department of surgery urology unit \u003c/p\u003e\n\u003cp\u003e6=MD, general surgeon and urological surgery fellow at Addis Ababa university college of health science department of surgery urology unit\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSt Lezin MA, Stoller ML: Surgical ureteral injuries, Urology 38(6):497\u0026ndash;506, 1991.Steers WD, Corriere JN, Benson GS, et al: The use of indwelling ureteral stents in managing ureteral injuries due to external violence, J Trauma 25(10):1001\u0026ndash;1003, 1985.\u003c/li\u003e\n\u003cli\u003eBerzeg S, Baumgart E, Beyersdorff D, Lenk S, Kopka L. Late complication of Boari bladder flap. Eur Radiol. 2003 Jul;13(7):1604-7. doi: 10.1007/s00330-002-1599-4. Epub 2002 Sep 10. PMID: 12835973.\u003c/li\u003e\n\u003cli\u003eMauck RJ, Hudak SJ, Terlecki RP, Morey AF. Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol. 2011 Oct;186(4):1345-9. doi: 10.1016/j.juro.2011.05.086. PMID: 21855904. \u003c/li\u003e\n\u003cli\u003ePearson BS. Experiences with the Boari flap. Br J Urol. 1970 Dec;42(6):740. PMID: 5491930.\u003c/li\u003e\n\u003cli\u003eSionov BV, Taha T, Preter D, Salbaq RA, Engelstein D, Tsivian A. Re-do Boari flap for recurrent ureteric stricture. Int Braz J Urol. 2021 May-Jun;47(3):670-673. doi: 10.1590/S1677-5538.IBJU.2020.0491. PMID: 33621021; PMCID: PMC7993970.\u003c/li\u003e\n\u003cli\u003eS. ALSAADI; H. Toussi; M. Alseiari; M. Al Ahmed; M. Zaman. POS-749 Boari flap Ureteric Re-implantation, a Salvage Procedure for Kidney Transplant Ureteral Stenosis. Kidney International Reports, ISSN: 2468-0249, Vol: 7, Issue: 2, Page: S324 Publication Year2022. http://www.sciencedirect.com/science/article/pii/S2468024922007859; http://dx.doi.org/10.1016/j.ekir.2022.01.785; https://linkinghub.elsevier.com/retrieve/pii/S2468024922007859; https://dx.doi.org/10.1016/j.ekir.2022.01.785\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Placenta percreta, recurrent ureteric stricture, Re-do Boari flap, Ureteric injury, Hydronephrosis","lastPublishedDoi":"10.21203/rs.3.rs-6590013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6590013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"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.","manuscriptTitle":"Case Report: Re-do Boari flap for recurrent ureteric stricture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 11:38:24","doi":"10.21203/rs.3.rs-6590013/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4828268b-56ca-43ef-a9b0-af8f34acd45b","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T11:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 11:38:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6590013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6590013","identity":"rs-6590013","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}