Clinical success of buccal mucosal graft in open ureteroplasty for proximal ureteral stricture

Proximal ureteric strictures remain problematic in urological cases, with few treatment options. Buccal mucosal grafts (BMGs) are in wide use for urethral reconstruction and provide suitable characteristics for optimal ureteral stricture repair. In this case, a 72-year-old patient was referred for consideration of left proximal ureteric reconstruction with a 4–5 cm stricture after failure of endoscopic management for a neglected stent. The patient had good contralateral kidney function, and he underwent an open ventral onlay ureteroplasty with BMG. Endoluminal visualization and retrograde ureterography reported success of the repair up to 16 weeks post-operatively. The patient remained symptom free at the time of this case report. The favourable outcome of this case is supported by the literature with the caveat of few case reports and varied follow-up. Overall, this case provides a positive outlook for the widespread adoption of BMGs in ureteral reconstruction. Lay Summary: The drainage of urine is important to keep the kidneys functioning well and to remove unwanted substances from the body - this relies on the ureters (the tubes connecting the kidneys to the bladder) to remain open to help drain the urine out of the body. In this case, a 72 year old gentleman suffered from a narrowed ureter causing blockage and loss of function of his left kidney. This was repaired by using tissue the inside of his cheek (called a buccal mucosal graft) to replace the narrowed part of his ureter in an operation. This operation proceeded without complication and the left kidney showed improved drainage sixteen weeks afterwards. We present this case in the hopes that it provides a positive outlook for the widespread adoption of this surgical technique.