Oral mucosa graft ureteroplasty: defining its role in complex ureteral reconstruction

Oral mucosa graft ureteroplasty has emerged as an organ-sparing option for complex ureteral strictures, potentially avoiding bowel interposition or renal autotransplantation in selected patients. This review is timely because indications, technical variants, and outcome definitions remain heterogeneous, and contemporary series are expanding the evidence base.

Across predominantly retrospective cohorts, oral mucosa grafting is most frequently applied to proximal and mid-ureteral strictures of several centimetres, including redo and post-endoscopic etiologies. Reported success is high when a well-vascularized bed is ensured and postoperative surveillance is standardized. Technical themes include onlay versus augmented anastomotic repairs, the selective use of vascularized coverage (omental or retroperitoneal/perinephric fat), and growing attention to donor-site morbidity, which is generally low but inconsistently reported.

Oral mucosa graft ureteroplasty should be considered within the reconstructive ladder for carefully selected complex strictures where primary anastomosis or reimplantation is not feasible, and where more morbid substitutes can be deferred. Future priorities include standardized definitions of success, comparative studies against ileal ureter and autotransplantation, and long-term renal functional outcomes with patient-reported measures.