Multiple ureteral strictures repaired by buccal mucosal graft ureteroplasty and non-transecting ureteroneocystostomy

Abstract

Objective: To describe the technique of open ureteral repair for multiple strictures, and its surgical outcome, in a patient who previously underwent laparoscopic total hysterectomy and bilateral salpingectomy (THBS). Patient and surgical procedure: We report a 46-year-old female who developed multiple ureteral strictures in her right ureter, four months after undergoing laparoscopic hysterectomy, bilateral salpingectomy. The proximal stricture was measured to be 3 cm while the distal stricture was 2 cm in length. The surgical technique consisted of open laparotomy, enterolysis, non-transecting side-to-side vesicoureteroanastomosis for the distal ureteral stricture. The proximal stricture was repaired using buccal mucosal graft to augment its lumen. There was no note of stricture recurrence on cystoscopy and retrograde pyelogram on short term follow-up. Results: Total operative time was three hours. Blood loss was approximately 300 ml. There were no complications intraoperatively and in the immediate perioperative period. At 6 months follow-up, cystoscopy and retrograde pyelography were performed which showed a healthy ureteral orifice with good peristaltic movements, and a non-dilated ureter. Conclusion: Repair of synchronous ureteral strictures can be performed using a combination of a non-transecting ureteroneocystostomy and buccal mucosal graft ureteroplasty. The technique is easily reproducible with good results and low morbidity, on short term follow-up.

Keywords

• Ureteral stricture
• Ureteroplasty
• Buccal mucosal graft
• Nontransecting
• Ureteroneocystostomy