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Autologous Tissue Substitutes for Ureteral Reconstruction: A Systematic Review of Surgical Techniques and Outcomes
Francesco Ditonno1, Sonia Costantino1, Lorenzo Pierangelo Treccani1
1Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
Background And Objective:
Ureteral strictures (USTs) are increasingly common. While some can be managed endoscopically, many cases require reconstructive surgery. Autologous tissue substitutes (ATSs) are a promising option in this setting. The aim of our systematic review was to map surgical techniques and outcomes for ureteral reconstruction using various ATS options.
Methods:
We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for studies on ATS ureteroplasty. Seventeen studies (559 patients) reporting on buccal mucosa grafts (BMGs), lingual mucosa grafts (LMGs), appendiceal techniques, vesical mucosa grafts (VMGs), and reconfigured intestinal segments were included. Owing to substantial clinical heterogeneity for graft types, surgical techniques, outcome definitions, and follow-up protocols, a quantitative meta-analysis was not feasible. A narrative synthesis was therefore used to report technical aspects and outcomes.
Key Findings And Limitations:
The most common UST causes were iatrogenic and stone-related. In most of the studies included, more than one-third of the patients enrolled had a history of ureteral repair. Short-term success rates were 85-100% for BMGs/LMGs, 85-93% for appendiceal techniques, and 100% in the single VMG series, but definitions of success varied widely across the studies. BMGs/LMGs were most frequently used for shorter strictures (<5 cm), whereas appendiceal techniques were used for longer defects (up to 7.5 cm). Limitations include the retrospective nature of most studies, heterogeneous reporting of outcomes, and short follow-up, which precluded meta-analysis and long-term assessment of efficacy.
Conclusions And Clinical Implications:
ATSs are a viable option for ureteral reconstruction. Graft choice should be tailored to the stricture length and location. These techniques require specialised expertise but can prevent more morbid procedures.
Patient Summary:
This review looked at use of a patient's own tissue (eg, from the inside of the cheek or the appendix) to repair the tube draining urine from the kidney to the bladder when it is blocked by a narrow segment. Results show that these techniques work very well and can often prevent the need for more invasive surgery. The type of tissue chosen depends on the exact nature and location of the blockage.
