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The Boari bladder flap: an effective continent stoma for the high‐compliance neurogenic bladder
Author(s) -
Baumgart Egbert,
Stoffel John T.
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.09004.x
Subject(s) - medicine , stoma (medicine) , urinary system , surgery , bladder augmentation , urinary diversion , urinary bladder , urinary continence , urology , bladder cancer , catheter , cystectomy , cancer , prostate , prostatectomy
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To determine if a continent urinary stoma can be created effectively using a Boari bladder flap (BBF) technique. PATIENTS AND METHODS Selected patients (15, eight women and seven men) with a neurogenic bladder and a bladder compliance of >20 mL/cmH 2 O had a procedure to create a BBF continent urinary stoma. The technique consisted of tubularising a trapezoidal, full‐thickness detrusor flap 10 cm long, 5–6 cm wide at the base and 2 cm at the tip, over a 12 F catheter, and plication of detrusor muscle around the stomal base. Outcomes after surgery were assessed by reviewing stomal continence, stomal patency, and stability of the upper urinary tract. RESULTS Ten BBF procedures were performed using native detrusor muscle, four with enterocystoplasty tissue and one in a defunctionalized bladder. Over a mean follow‐up of 13 months, 11 patients had functioning stomas and 10 of these reported complete stomal continence. The mean change in serum creatinine level from the preoperative baseline for all patients was 0.1 mg/dL. The odds ratio for procedural failure, defined as a stoma unusable for self‐catheterization, was 7.5 ( P = 0.04) when the BBF was created from augmented or defunctionalized bladder tissue, compared to native high‐compliance detrusor. CONCLUSION A BBF can be used to create a viable, functional stoma in the high‐compliance neurogenic bladder, although the rate of stomal complications is high when the BBF is created from enterocystoplasty tissue.