A Novel Technique of Robotic Buccal Mucosal Graft Ureteroplasty for Proximal Ureteric Strictures by Non-transecting Mucosa-to-Mucosa Anastomosis

TL;DR

A new robotic technique for fixing narrow ureteric strictures uses a non-transecting mucosa-to-mucosa anastomosis with a buccal graft to preserve blood flow and reduce recurrence.

Contribution

The novel technique adapts mucosal-sparing principles from urethroplasty to ureteroplasty, preserving vascularity during stricture repair.

Findings

Non-transecting mucosa-to-mucosa anastomosis was successfully applied to proximal ureteric strictures.

The technique aims to preserve vascularity and potentially reduce stricture recurrence.

Preoperative imaging and intraoperative studies were used to guide the procedure.

Abstract

Buccal mucosal graft (BMG) ureteroplasty is a well-established technique for complex upper ureteric strictures, particularly with robotic assistance. However, limited guidance exists for cases involving a narrow ureteral plate. We present a novel technique employing a non-transecting mucosa-to-mucosa anastomosis at the stricture site, followed by BMG augmentation. This method adapts the principles of non-transecting urethroplasty (mucosal-sparing augmented non-transected anastomotic (MsANTA)) to the ureter, aiming to preserve vascularity. Patients underwent preoperative CT urography and intraoperative retrograde studies to delineate the stricture. After harvesting the buccal graft and identifying the narrow ureteral plate, mucosal approximation without transection was performed to widen the lumen, followed by watertight graft anastomosis. This vascular-preserving modification may reduce stricture recurrence. Further comparative studies are warranted to validate its efficacy.

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