Replacement plastic reconstruction of extended ureteral stricture using buccal mucosa autograft

The potentials for the use of free buccal mucosa graft in reconstruction plastic surgery of extended uretral stricture are evaluated. From 2007 to 2013, 9 operations in 8 patients (mean age 54,5±7,2 years) were performed. The average length of cicatricial uretral stricture was 5,1±0,7 cm. 1 patient has lesion in the upper third of the ureter, 4 patients - in the middle portion, and 4 patients - at the bottom portion. The causes of extended uretral stricture were following: long standing calculi (n=3), ureteral injury after ureterolithotripsy (n=2) and after bringing down the calcuus using loop (n=1), radiotherapy (n=3, one patient had bilateral injury). All patients underwent plastic reconstruction of ureter using buccal mucosa graft by «on-lay» type. During the follow-up (median, 42 months, from 3 to 72 months), in 7 (88,9 %) of 8 patients (8 operations) ureteral strictures relapses were not observed. They all had satisfactory renal excretory function without the pronounced violations of passage of urine along the ureter. The excretory urography showed moderate expansion of the ureter at the site of operation in 6 of them. Due to the progression of secondary renal scarring, one patient underwent nephrectomy 1.5 year after reconstruction plastic surgery. In this patient, pronounced anatomical and functional changes in the kidney occurred before the operation. Application of the buccal mucosa graft in reconstruction plastic surgery in extended uretral stricture is high effective due to the relatively low level of early and late postoperative complications and low recurrence rate.

ureterostenosis, buccal mucosa, autograft