Ureteroplasty with buccal flap: indications, technique, alternative methods

This literature review is devoted to the analysis of indications for ureteroplasty with a buccal flap, its technique, and the alternative surgical options. Reconstructive surgery of the ureter has more than a century of history, during which various surgical interventions have been proposed and improved depending on the location and length of the stricture. Over the past decades, a method of replacing the ureter with a flap from the buccal or tongue mucosa was introduced. The use of such flaps for the ureteral reconstruction is not a new concept; the possibility of performing such a procedure was confirmed at the end of the last century. Successful results of experimental and clinical studies have allowed the gradual adoption of this technique to replace long defects in the upper and middle third of the ureter. In buccal ureteroplasty, robot-assisted approach is widely used, contributing to a high success rate and fewer postoperative complications. The accumulation of experience in such reconstructive procedures and the analysis of the results allow to clarify the indications and contraindications, improve the technique, and carry out multicenter studies.

According to the literature, ureteroplasty using a buccal or tongue mucosa flap is most suitable for long narrowing of the ureteropelvic junction, the upper and middle third of the ureter, which are amenable to endoscopic procedures or segmental resection with end-to-end anastomosis.