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A Review of Buccal Mucosa Graft Ureteroplasty

  • Surgery (J Simhan, Section Editor)
  • Published:
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Abstract

Purpose of Review

We review the buccal mucosa graft (BMG) ureteroplasty literature to evaluate its utility in the management of ureteral strictures, identify indications for which it is particularly useful, and highlight refinements in surgical technique.

Recent Findings

Recent reports have described the efficacy of robotic BMG ureteroplasty and the utilization of near-infrared fluorescence to assist with precise identification of the ureteral stricture margins.

Summary

BMG ureteroplasty is well-suited for ureteral reconstruction as it allows for minimal disruption of the delicate ureteral blood supply and facilitates a tension-free anastomosis. This technique is particularly useful in patients with long ureteral strictures not amenable to ureteroureterostomy and in patients with a recurrent ureteral stricture after a previously failed ureteral reconstruction.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mohamed Aly Elkoushy SA. Surgical, radiologic, and endoscopic anatomy of the kidney and ureter. 11th ed. Campbells-Walsh Urology. Philadelphia: Saunders-Elsevier Health Sciences; 2015.

  2. Lee Z, Llukani E, Reilly CE, Mydlo JH, Lee DI, Eun DD. Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults. J Endourol. 2013;27(8):994–9.

    Article  PubMed  Google Scholar 

  3. Stief CG, Jonas U, Petry KU, Sohn C, Bektas H, Klempnauer J, et al. Ureteric reconstruction. BJU Int. 2003;91(2):138–42.

  4. Wenske S, Olsson CA, Benson MC. Outcomes of distal ureteral reconstruction through reimplantation with psoas hitch, Boari flap, or ureteroneocystostomy for benign or malignant ureteral obstruction or injury. Urology. 2013;82(1):231–6.

    Article  PubMed  Google Scholar 

  5. Hofer MD, Aguilar-Cruz HJ, Singla N, Cordon BH, Scott JM, Morey AF. Expanding applications of renal mobilization and downward nephropexy in ureteral reconstruction. Urology. 2016;94:232–6.

    Article  PubMed  Google Scholar 

  6. • Lee Z, Waldorf BT, Cho EY, Liu JC, Metro MJ, Eun DD. Robotic ureteroplasty with buccal mucosa graft for the management of complex ureteral strictures. J. Urol. 2017;198(6):1430–5. Largest experience with BMG ureteroplasty (12 patients).

    Article  PubMed  Google Scholar 

  7. •• Zhao LC, Yamaguchi Y, Bryk DJ, Adelstein SA, Stifelman MD. Robot-assisted ureteral reconstruction using buccal mucosa. Urology. 2015;86(3):634–8. First experience with robotic BMG ureteroplasty.

  8. Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it the new gold standard? BJU Int. 2004;93(9):1191–3.

    Article  CAS  PubMed  Google Scholar 

  9. • Markiewicz MR, DeSantis JL, Margarone JE 3rd, Pogrel MA, Chuang SK. Morbidity associated with oral mucosa harvest for urological reconstruction: an overview. J. Oral Maxillofac. Surg. 2008;66(4):739–44. Low complication rate associated with BMG harvesting.

    Article  PubMed  Google Scholar 

  10. Barbagli G, Lazzeri M. Urethral reconstruction. Curr Opin Urol. 2006;16(6):391–5.

    Article  PubMed  Google Scholar 

  11. • Powell SJ, Engelbrecht HE, Welchman JM. Hydronephrosis and urinary tract bilharziasis. A radiological and necropsy survey. Trans. Royal Soc Trop. 1968;62(2):231–7. Atonic ureters drain via gravity.

    Article  CAS  Google Scholar 

  12. • Naude JH. The natural history of ureteric bilharzia. Br J Urol. 1984;56(6):599–601. Atonic ureters drain via gravity.

    Article  CAS  PubMed  Google Scholar 

  13. •• Somerville JJ, Naude JH. Segmental ureteric replacement: an animal study using a free non-pedicled graft. Urol Res. 1984;12(2):115–9. First experience with BMG ureteroplasty in an animal model.

    Article  CAS  PubMed  Google Scholar 

  14. •• Naude JH. Buccal mucosal grafts in the treatment of ureteric lesions. BJU Int. 1999;83(7):751–4. First experience with BMG ureteroplasty in humans.

  15. • Kroepfl D, Loewen H, Klevecka V, Musch M. Treatment of long ureteric strictures with buccal mucosal grafts. BJU Int. 2010;105(10):1452–5. Longest ureteral stricture repaired with BMG ureteroplasty (11 cm).

    Article  PubMed  Google Scholar 

  16. • Badawy AA, Abolyosr A, Saleem MD, Abuzeid AM. Buccal mucosa graft for ureteral stricture substitution: initial experience. Urology. 2010;76(4):971–5. Largest experience with tubularized BMG ureteroplasty.

    Article  PubMed  Google Scholar 

  17. Fahmy O, Schubert T, Khairul-Asri MG, Stenzl A, Gakis G. Total proximal ureter substitution using buccal mucosa. Int J Urol. 2017;24(4):320–3.

    Article  PubMed  Google Scholar 

  18. Andrich DE, Mundy AR. Substitution urethroplasty with buccal mucosal-free grafts. J Urol. 2001;165(4):1131–3.

    Article  CAS  PubMed  Google Scholar 

  19. Patterson JM, Chapple CR. Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol. 2008;53(6):1162–71.

    Article  PubMed  Google Scholar 

  20. Stein R, Rubenwolf P, Ziesel C, Kamal MM, Thuroff JW. Psoas hitch and Boari flap ureteroneocystostomy. BJU Int. 2013;112(1):137–55.

    Article  PubMed  Google Scholar 

  21. Stolzenburg JU, Rai BP, Do M, Dietel A, Liatsikos E, Ganzer R, et al. Robot-assisted technique for Boari flap ureteric reimplantation: replicating the techniques of open surgery in robotics. BJU Int. 2016;118(3):482–4.

  22. Riedmiller H, Becht E, Hertle L, Jacobi G, Hohenfellner R. Psoas-hitch ureteroneocystostomy: experience with 181 cases. Eur Urol. 1984;10(3):145–50.

    Article  CAS  PubMed  Google Scholar 

  23. Bowsher WG, Shah PJ, Costello AJ, Tiptaft RC, Paris AM, Blandy JP. A critical appraisal of the Boari flap. Br J Urol. 1982;54(6):682–5.

    Article  CAS  PubMed  Google Scholar 

  24. Thompson IM, Ross G Jr. Long-term results of bladder flap repair of ureteral injuries. J Urol. 1974;111(4):483–7.

    Article  CAS  PubMed  Google Scholar 

  25. Mauck RJ, Hudak SJ, Terlecki RP, Morey AF. Central role of Boari bladder flap and downward nephropexy in upper ureteral reconstruction. J Urol. 2011;186(4):1345–9.

    Article  PubMed  Google Scholar 

  26. Armatys SA, Mellon MJ, Beck SD, Koch MO, Foster RS, Bihrle R. Use of ileum as ureteral replacement in urological reconstruction. J Urol. 2009;181(1):177–81.

  27. Chung BI, Hamawy KJ, Zinman LN, Libertino JA. The use of bowel for ureteral replacement for complex ureteral reconstruction: long-term results. J Urol. 2006;175(1):179–83.

    Article  PubMed  Google Scholar 

  28. Cowan NG, Banerji JS, Johnston RB, Duty BD, Bakken B, Hedges JC, et al. Renal autotransplantation: 27-year experience at 2 institutions. J Urol. 2015;194(5):1357–61.

  29. Eisenberg ML, Lee KL, Zumrutbas AE, Meng MV, Freise CE, Stoller ML. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation. J Urol. 2008;179(1):240–3.

    Article  PubMed  Google Scholar 

  30. Roth JD, Monn MF, Szymanski KM, Bihrle R, Mellon MJ. Ureteral reconstruction with ileum: long-term follow-up of renal function. Urology. 2017;104:225–9.

    Article  PubMed  Google Scholar 

  31. Pandey A, Dican R, Beier J, Keller H. Buccal mucosal graft in reconstructive urology: uses beyond urethral stricture. Int J Urol. 2014;21(7):732–4.

    Article  PubMed  Google Scholar 

  32. Ambani SN, Yang DY, Wolf JS Jr. Matched comparison of primary versus salvage laparoscopic pyeloplasty. World J Urol. 2017;35(6):951–6.

    Article  PubMed  Google Scholar 

  33. Etafy M, Pick D, Said S, Hsueh T, Kerbl D, Mucksavage P, et al. Robotic pyeloplasty: the University of California-Irvine experience. J Urol. 2011;185(6):2196–200.

  34. Arora S, Campbell L, Tourojman M, Pucheril D, Jones LR, Rogers C. Robotic buccal mucosal graft ureteroplasty for complex ureteral stricture. Urology. 2017;110:257–8.

    Article  PubMed  Google Scholar 

  35. Zampini AM, Nelson R, Zhang JJH, Reese J, Angermeier KW, Haber GP. Robotic salvage pyeloplasty with buccal mucosal onlay graft: video demonstration of technique and outcomes. Urology. 2017;110:253–6.

    Article  PubMed  Google Scholar 

  36. Bjurlin MA, Gan M, McClintock TR, Volpe A, Borofsky MS, Mottrie A, et al. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol. 2014;65(4):793–801.

    Article  PubMed  Google Scholar 

  37. • Hockenberry MS, Smith ZL, Mucksavage P. A novel use of near-infrared fluorescence imaging during robotic surgery without contrast agents. J Endourol. 2014;28(5):509–12. Ureteroscopy and NIRF to identify ureteral stricture margins.

    Article  PubMed  Google Scholar 

  38. • Lee Z, Moore B, Giusto L, Eun DD. Use of indocyanine green during robot-assisted ureteral reconstructions. Eur Urol. 2015;67(2):291–8. Intraureteral ICG and subsequent visualization under NIRF to identify ureteral stricture margins.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Temple University School of Medicine, 255 S 17th Street, 7th Floor Medical Tower, Philadelphia, PA, 19103, USA

    Ziho Lee, Aryeh Y. Keehn, Matthew E. Sterling, Michael J. Metro & Daniel D. Eun

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  1. Ziho Lee
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  2. Aryeh Y. Keehn
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  3. Matthew E. Sterling
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  4. Michael J. Metro
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  5. Daniel D. Eun
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Corresponding author

Correspondence to Daniel D. Eun.

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Conflict of Interest

Ziho Lee, Aryeh Y. Keehn, Matthew E. Sterling, and Michael J. Metro each have no conflicts of interest or financial ties to disclose.

Daniel D. Eun is a paid speaker and proctor and performs meeting activities for Intuitive Surgical, Consultant for Medtronic, and Founder and shareholder of Melzi Corp.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Surgery

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Lee, Z., Keehn, A.Y., Sterling, M.E. et al. A Review of Buccal Mucosa Graft Ureteroplasty. Curr Urol Rep 19, 23 (2018). https://doi.org/10.1007/s11934-018-0772-5

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  • DOI: https://doi.org/10.1007/s11934-018-0772-5

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