Buccal mucosal graft in ureteral strictures: A case series and review of literature

ObjectiveProximal ureteric stricture is one of the many challenging problems urologists face. We aim to evaluate the results of buccal mucosal graft ureteroplasty at our institution. MethodologyAll buccal mucosal graft ureteroplasties performed at the Princess Margaret Hospital, Hong Kong, between December 2020 and July 2022 were reviewed. This review included patients with ureteric strictures of different aetiologies and various stricture lengths. Collected data consisted of patients' demographics, previous interventions, surgical approach, early and intermediate outcomes. ResultsSix patients (median age 59.5 years) were included in this case series. Four had previously failed ureteral interventions. Pre-operatively four had ureteral stents and two were on nephrostomy tubes. Five had a robotic-assisted laparoscopic repair while one had an open repair. Onlay graft was performed in five patients and augmented anastomotic repair in one patient. The median stricture length was 2 cm. Median operative time was 268 min, estimated blood loss was 200 mL, and length of stay was 7.5 days. Four patients with adequate follow-up were considered successful at a median follow-up of 13.7 months.There were no intra-operative complications. Anastomotic leakage and donor site bleeding were observed in one patient (Clavien-Dindo III). ConclusionBuccal mucosal graft ureteroplasty is suitable in appropriately selected patients with proximal ureteral strictures. Robotic surgical approaches have made this technique promising. Long-term outcomes are eagerly awaited.