Introduction. Ureteral stricture is an anatomical narrowing of the ureteral lumen with obstruction of the upper urinary tract. The causes of ureteral stricture vary, but in modern practice, it is most often due to iatrogenic injuries during endourological procedures. Lithodestruction increases the risk of ureteral stricture development. Treatment strategies for strictures are determined by the location, extent, and time since injury. Currently, there is no universal ureteroplasty method, nor is there an optimal viable plastic material for correcting all types of cicatricial sclerotic changes in the ureter. Therefore, finding a solution to this problem and further studying the results of substitution ureteroplasty techniques is essential.
The aim of this study was to evaluate the efficacy and safety of laparoscopic ureteroplasty using an oral mucosa graft in the treatment of extended ureteral strictures. To expand knowledge about the possibilities of substitution surgery, the reproducibility of the method, and an alternative solution to a common problem.
Materials and methods. A single-center prospective study was conducted to evaluate the treatment outcomes of 20 patients with extensive ureteral stric¬tures (obliterations) of various locations at the Center for Urology, Nephrology, and Lithotripsy of the N.A. Semashko Russian Railways-Medicine Clinical Hospital from August 2020 to April 2025.
Results. The overall success of the method was 90% (18/20 patients). In two (10%) patient, the method was ineffective after the first stage: one required endoscopic incision of the recurrent stricture zone, in the second, a full effect, due to the failure of the anastomosis after tubularizing plastic surgery after 2 months, was achieved by prolonged internal drainage for another 1 month. At the examination after 1 month, the anastomosis was determined to be valid and there was no obstruction. The most frequent complications were short-term oral symptoms (25%) and postoperative pyelonephritis (10%). There was a statistically significant improvement in urodynamic parameters according to MSCT, ultrasound, renoscintigraphy, and a significant decrease in the degree of hydronephrosis. There were no serious complications (Grade IV–V) associated with the buccal flap harvesting procedure or the reconstruction method.
Conclusion. Laparoscopic ureteral replacement plastic with buccal graft is effective, safe and feasible for long-term strictures of the middle third of the ureter.
