The Boari bladder flap: an effective continent stoma for the high-compliance neurogenic bladder.

Abstract

To determine if a continent urinary stoma can be created effectively using a Boari bladder flap (BBF) technique. 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. 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. 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.