Buccal mucosal graft for onlay ureteroplasty in the management of proximal ureteral stricture. Single centre, prospective trial.

Abstract

Objectives: To evaluate the outcomes of oral buccal mucosa graft (BMG) ureteroplasty in managing recurrent long-segment proximal ureteric strictures and recurrent uretero-pelvic junction obstruction (UPJO).

Methods: A single-centre prospective study included patients with recurrent long-segment proximal ureteric strictures and recurrent UPJO treated with open onlay BMG ureteroplasty from January 2022 to September 2024. Patient demographics, intraoperative and postoperative characteristics, and the percentage of stricture-free status at the last visit were documented. Complication rates were categorized according to the modified Clavien-Dindo grading system Results: The study included 21 patients, 11 males (52.4%) and 10 females (47.6%), with a mean age ± SD of 45.8 ± 13.7 years. Regarding the stricture etiology, Ten patients (47.6%) had previously undergone complicated endoscopic stone surgeries, seven patients (33.3%) had a history of open surgery for stone disease, while the remaining four (19%) had undergone previously failed pyeloplasty for congenital UPJO. The mean operative time was 145 minutes, the mean stricture length ±SD was 3.94±1.4 cm, and the mean harvested BMG length ±SD was 7.6±1.1 cm. Six patients (28.6%) developed postoperative complications of Clavien II and III grade. The follow-up duration ranged from 9 to 24 months, with a mean duration of 16.3 months. At the last follow-up visit, 18 out of 21 patients (85.7%) were stricture-free.

Conclusions: Buccal mucosa graft for onlay ureteroplasty represents an effective surgical intervention for managing recurrent, long-segment proximal ureteric strictures and recurrent cases of ureteropelvic junction obstruction.