PUJ Obstruction in a Transplant Kidney: Reconstruction by Boari Flap

Background and Aims: Renal transplantation remains a crucial treatment for end-stage renal disease, though post-operative complications such as ureteral obstruction can jeopardise graft survival. Methods: Here, we report a case of a 52-year-old male with IgA nephropathy who developed ureteric complications following an ABO-compatible renal transplant. Results: Despite successful induction therapy and initial discharge with stable graft function, the patient experienced recurrent infections, suture site leakage, progressively worsening hydronephrosis and graft dysfunction. Imaging and nephrostomogram identified a pelviureteric junction (PUJ) obstruction with a short, non-functional ureter unsuitable for conventional reconstruction. After detailed evaluation, a Boari bladder flap reconstruction was performed, successfully establishing a direct connection between the bladder and renal pelvis. Post-surgery, the patient demonstrated stable renal function with improved creatinine levels and no complications during follow-up. Conclusion: This case demonstrates the Boari bladder flap’s effectiveness as a practical and efficient method of treating ureteral obstruction in patients with renal transplants whose ureters are impaired in length.