AB007. SOH26AB_0364. Modified augmented buccal mucosa ureteroplasty to reduce the length of graft required to repair a long proximal stricture

Long strictures in the proximal ureter are technically challenging to repair. We present the case of a nephrostomy-dependent 50-year-old gentleman with a proximal left ureteral stricture, who underwent a robotic-assisted ureteroplasty. The procedure was performed using the da Vinci robot, LithoVue ureteroscope, indocyanine green (ICG) dye, and buccal mucosal graft. The stricture spanned approximately 5 cm, resulting in complete ureteral obliteration. Typically, this would require either a dorsal onlay buccal graft or an augmented buccal graft (excision of the stricture, reconstruction of the back wall, and dorsal onlay of graft). However, we modified the technique by reducing the length of the stricture without excising any ureteral tissue. A modified augmented buccal mucosa ureteroplasty was performed, with healthy mucosa proximal and distal to the stricture sutured together. This approach meant only a 1 cm graft was required, reduced potential morbidity, and preserved blood supply to the ureter, preventing retraction of the ends. The patient had an unremarkable postoperative course and had his ureteral stent removed 3 weeks later with no complications. This step-by-step video demonstrates a buccal mucosa ureteroplasty using a small graft to repair a long segment of strictured ureter.