Login to Access Video or Poster Abstract: MP24-01
Sources of Funding: None

Introduction

Buccal mucosa is well-suited for grafting in the urinary tract as it is compatible with a wet environment, has a thick epithelium that facilitates tissue handling, and has a highly vascular lamina propria that promotes imbibition and inosculation. Despite this, the use of buccal mucosa grafts in ureteral reconstruction has been limited. We report our multi-institutional experience with robotic ureteroplasty with buccal mucosa graft.

Methods

We retrospectively reviewed 25 patients who underwent robotic ureteroplasty with buccal mucosa graft by three primary surgeons at three institutions between October 2013 and October 2016. Indication for the procedure was a proximal or mid ureteral stricture not amenable to primary anastomosis secondary to length of stricture or extensive fibrosis. On follow-up, patients were assessed for: clinical success, the absence of symptoms from ureteral pathology; and radiological success, the absence of ureteral obstruction on imaging, which included renal scan, CT urogram, and/or ultrasound.

Results

In 21/25 (84.0%) cases, the diseased ureter was incised and a buccal mucosa graft was onlayed over the defect. In 4/25 (16.0%) cases, the diseased ureter was transected, a plate of healthy ureter was brought together, and buccal mucosa graft was used to perform an augmented ureteroplasty. Eighteen of 25 (72.0%) patients had proximal and 9/27 (28.0%) patients had mid ureteral strictures. Ten of 25 (40.0%) patients had previously undergone a failed ureteral reconstruction. The median length of stricture was 4.0 cm (range 2.0-8.0 cm), and length of buccal mucosa graft harvested was 4.0 cm (range 2.5-8.0 cm). The buccal mucosa graft was onlayed ventrally in 21/25 (84.0%) and dorsally in 4/25 (16.0%) patients. The anastomosis was reinforced with peri-renal fat in 1/25 (4.0%), omentum and appendix in 1/25 (4.0%), and only omentum in 23/25 (92.0%) cases. The median operative time was 203 min (range 136-397 min), estimated blood loss was 100 ml (range 25-420 ml), and length of stay was 2 days (range 1-15 days). There were no intraoperative complications. At a median follow-up of 8 months (range 0-32 months), 23/25 (92.0%) cases were clinically and radiologically successful.

Conclusions

Robotic ureteroplasty with buccal mucosa graft is an effective technique for managing complex proximal and mid ureteral strictures with excellent short-medium term outcomes.

Funding

None