Role of buccal mucosa graft ureteroplasty in the surgical management of pyeloplasty failure

doi:10.1016/j.ajur.2023.09.001

Asian Journal of Urology, 2024, 11 (3): 373-376 doi: 10.1016/j.ajur.2023.09.001

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Role of buccal mucosa graft ureteroplasty in the surgical management of pyeloplasty failure

Matthew Lee^a,*(

),Elizabeth Nagoda^a,David Strauss^a,Matthew Loecher^a,Michael Stifelman^b,Lee Zhao^c

^aDepartment of Urology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
^bDepartment of Urology, Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
^cDepartment of Urology, New York University Grossman School of Medicine, New York University Langone Health System, New York, NY, USA

Abstract
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Abstract

Objective: Secondary pyeloplasty for recurrent ureteropelvic junction obstructions may be a safe and feasible surgical option for patients. This study aimed to demonstrate outcomes of utilizing a non-transecting buccal mucosa graft ureteroplasty for management of recurrent ureteropelvic junction obstruction after prior failed pyeloplasty.

Methods: We performed a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery database for all consecutive patients who underwent buccal mucosa graft ureteroplasty between April 2012 and June 2022 for management of recurrent ureteropelvic junction obstructions after prior failed pyeloplasty. The primary outcome included surgical success which was defined as the absence of flank pain and no obstruction on imaging.

Results: Overall, ten patients were included in our analysis. The median stricture length was 2.5 (interquartile range [IQR] 1.8-4.0) cm. The median operative time was 230.5 (IQR 199.5-287.0) min and median estimated blood loss was 50.0 (IQR 28.8-102.5) mL. At a median follow-up of 10.3 (IQR 6.2-14.8) months, 80% of patients were surgically successful and there were no major (Clavien-Dindo Grade>2) complications.

Conclusion: Buccal mucosa graft ureteroplasty is a valuable non-transecting surgical option for patients with recurrent ureteropelvic junction obstructions who failed prior pyeloplasty and has comparable outcomes to the literature regarding standard transecting techniques.

Key words： Ureteral obstruction Buccal mucosa graft Pyeloplasty Robotic Stricture

Received: 03 July 2023 Available online: 20 July 2024

Corresponding Authors: *E-mail address: matthewlee019@gmail.com (M. Lee).

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Cite this article:

Matthew Lee,Elizabeth Nagoda,David Strauss, et al. Role of buccal mucosa graft ureteroplasty in the surgical management of pyeloplasty failure[J]. Asian Journal of Urology, 2024, 11(3): 373-376.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.09.001 OR http://www.ajurology.com/EN/Y2024/V11/I3/373

Buccal mucosa graft ureteroplasty. (A) Intravenous indocyanine was utilized for stricture identification and the strictured segment of the ureteropelvic junction appeared hypointense when visualized under near-infrared fluorescence; (B) A longitudinal incision was made along the ventral aspect of the ureteropelvic junction across the strictured segment and a ruler was utilized to measure the stricture length; (C) A buccal mucosa graft was anastomosed to the ventral defect in a running fashion using a 5-0 absorbable monofilament suture.

Patient demographics and preoperative variables.

Intraoperative details and follow-up results.

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