# Mitrofanoff Appendicovesicostomy With Boari Flap for Complete Female Urethral Transection: A Case Report

## TL;DR

A woman with a rare complete urethral injury was successfully treated using a Mitrofanoff procedure combined with a Boari flap to overcome surgical challenges.

## Contribution

The combination of Mitrofanoff appendicovesicostomy and a Boari flap is proposed as a novel solution for female urethral transection when reconstruction is not possible.

## Key findings

- The patient achieved stable clean intermittent catheterization post-surgery without complications.
- Urodynamic evaluation showed improved bladder compliance after the procedure.
- The Boari flap helped overcome the limited length of the appendix for the Mitrofanoff procedure.

## Abstract

Female urethral complete transection caused by pelvic trauma is extremely rare, and no standard management has been established when urethral reconstruction is not feasible.

A woman in her twenties sustained an open pelvic fracture with perineal injury due to a traffic accident. Complete urethral transection was identified, and a suprapubic cystostomy was placed. After staged vaginal reconstruction and bladder function evaluation, a Mitrofanoff appendicovesicostomy was performed. Because the appendix was not enough to reach the umbilicus, a Boari flap was created to compensate for the length. Urodynamic evaluation showed improvement from a preoperative high‐pressure bladder to increased compliance postoperatively, though pharmacological management was still required. Postoperatively, the patient achieved stable clean intermittent catheterization without complications.

The Mitrofanoff procedure can be an effective option in female urethral injuries where reconstruction is impossible. The addition of a Boari flap may expand its applicability by overcoming conduit length limitations.