[Laparoscopic substitution of the proximal ureter using buccal mucosa]

In patients with long ureteral strictures, bowel substitution of the ureter or kidney autotransplantation can be performed, which are technically demanding. For recurrent uretero-pelvic junction obstruction (UPJO) and proximal ureteral strictures, substitution of the ureter using buccal graft may be an alternative.

to study the results of laparoscopic ureteral substitution in patients with long proximal ureteral strictures using buccal graft.

Laparoscopic ureteral substitution of the ureter using buccal graft was performed in 10 patients with long proximal ureteral strictures, 7 of them were men. The average age was 43.5 years. In 6 patients there was a recurrence after previous pyeloplasty, while 3 patients had ureteroscopy due to upper ureteral stone and one patient had ureteral trauma during laparoscopic excision of the kidney cyst. Three patients were admitted to the hospital with nephrostomy tube, seven with a ureteral stent. Using a laparoscopic approach, an affected part of the ureter was dissected along its length, then a stent was placed antegrade and the ureter was substituted with buccal graft using the onlay technique.

All patients underwent laparoscopic intervention. There were no intraoperative complications. The duration of the procedure ranged from 170 to 340 minutes. There were no cases of anastomotic leakage. Fever was observed in one patient without nephrostomy drainage (Clavien grade I). On intravenous pyelography and computed tomography, the neoureter was wide and patent. In patients with PUJO, a severity of dilation of the collecting system was decreased over time. Clinically, all procedures were successful, as patients were free of nephrostomy tube and symptoms of upper urinary tract obstruction.

Ureteral substitution using buccal graft may be the method of choice in patients with long proximal ureteral strictures. It is relatively easy, since it does not require extensive dissection of the ureter and provides for the possibility of using buccal graft of the desired length.