Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture

Management of a long proximal ureteral stricture is challenging. Lingual mucosal graft ureteroplasty is a novel minimally invasive technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. Study evaluated the long-term effectiveness of lingual mucosal graft ureteroplasty for managing long, complex proximal ureteral strictures in a multi-institutional cohort of patients. The findings of the study are published in European Urology.

This retrospective study involved data for 41 patients treated with lingual mucosal graft ureteroplasty was performed using either an onlay ureteroplasty in which the diseased ureter was incised ventrally and repaired with a lingual mucosal graft (LMG) to widen the ureteral lumen, or an augmented anastomotic technique in which the obliterated segment of the ureter was excised and reanastomosed primarily on dorsal side, and an lingual mucosal graft was placed on the ventral side.

A total of 41patients, 40 were operated with laparoscopic procedures and one with a robot. Twenty-four (59%) patients underwent an onlay ureteroplasty, and 17 (41%) underwent an augmented anastomotic ureteroplasty. The reconstructed ureter was wrapped with omentum in 90% of cases. The median (range) stricture length was 4.8 cm (2.0–8.0), operative time was 166 min (98–306), and estimated blood loss was 65 ml (15-220). No open conversions and intraoperative complications occurred. At a median follow-up of 35 mo (range 13–80), the overall success rate was 97.6% (40/41).

Lingual mucosal graft ureteroplasty is a safe, feasible, and effective long-term technique for managing long, complex proximal ureteral strictures, concluded the researchers.