Robotic buccal mucosal graft ureteroplasty: a contemporary multi-institutional experience

The aim of our study was to evaluate and describe our multi-institutional experience with buccal mucosal graft (BMG) ureteroplasty for complex ureteral strictures. The primary outcomes analyzed were the need for re-intervention or revision surgery and the change in hydronephrosis of the affected renal unit.

All patients who underwent buccal mucosal graft-onlay ureteral reconstruction and had post-surgical follow-up including upper tract imaging at five tertiary care centers were retrospectively reviewed for a 4-year period. Patient demographics, perioperative metrics, and postoperative clinical outcomes were analyzed.

40 patients (23 female, 17 male; mean age 50.2 years) had upper urinary tract reconstruction with BMG. 55% had prior abdominal/pelvic surgery, and 17.5% had prior radiation therapy. Median follow-up was 12.2 months. The mean stricture length was 3.35 cm, predominantly located within the proximal ureter (47.5%) and left-sided (67.5%). Preoperative drainage was required in 50% of patients, 12 with a percutaneous nephrostomy tube (30%) and 8 with a ureteral stent (20%). Mean graft length was 4.47 cm, with an mean operative time of 271 min. The 30-day complication rate was 22.5%. Mean preoperative and postoperative hydronephrosis grades (SFU) improved significantly from 2.82 to 1.03 (p = 0.001). Surgical success, defined by improved imaging and absence of additional interventions, was achieved in 95% of cases.

Robotic assisted buccal mucosal ureteroplasty is an effective minimally invasive technique for treating complex ureteral strictures. Patients who were previously nephrostomy tube or ureteral stent dependent have restored physiologic upper tract drainage, experience a significant decrease in hydronephrosis and avoid the need for future surgery or intervention.