Reconstruction of ureteral stricture using buccal mucosal graft

Overview

Introduction: We present an innovative surgical procedure for the correction of ureteral stricture resulting from ureteroscopic laser lithotripsy of a stone. The risk factors are a bulky stone and high-energy laser use, both of which were present in our case. We present a case report of a successful robot-assisted surgery for a ureteral stricture, which was temporarily decompressed by nephrostomy. The use of a buccal graft has been successfully used in reconstructive surgeries and in urology since 1942, especially in urethroplasty. According to recent foreign presentations, the transferred buccal graft can also be used in upper urinary tract reconstructions. Case report: A 74-year-old man, after successful minimally invasive endoscopic treatment of ureterolithiasis, returns with recurrent symptoms. A follow-up CT scan reveals a proximal ureteral stricture, which gradually progresses to the point that it was necessary to insert a nephrostomy. The patient is experiencing significant discomfort with this derivation and wishes to have it resolved. In the surgical treatment of ureteral strictures, the use of buccal mucosal graft is recommended, and we decided to use this technique in our case. The video presentation shows the performance of this procedure. The operation began with the establishment of ports in the left half of the abdomen, the same as in partial nephrectomy. The ureter was dissected laterally from colon. It was necessary to dissect it free from tough adhesions. The ureteral stricture was resected, and the healthy ends of the ureters were sutured together on the dorsal side after spatulation. A buccal mucosal graft was sutured onto this dorsal plate. Buccal mucosal graft was taken during the preparation of the ureter by an experienced urologist and was inserted through the assistant port in a surgical glove finger. This graft was then sutured onto the ventral half of the reconstructed ureteral segment. A Ch 8 double J stent was inserted before complete closure. The surgery lasted 4 hours and 30 minutes, blood loss was minimal, the patient was in the recovery unit for 2 hours after the operation and then returned to the standard ward. The nephrostomy was removed on the seventh postoperative day and the stent after 2 months. The postoperative course of the patient was uncomplicated, and he is still without urinary diversion. Conclusion: A buccal mucosal graft is very suitable for use in complicated ureteral reconstruction, for example strictures. According to published data and our performed surgery, this significantly reduces the risk of recurrence.

Keywords:

ureteral stricture – laser lithotripsy of ureterolithiasis – complications of ureteroscopy – buccal mucosa graft