Buccal grafting of extended strictures of proximal ureter. (A literature Review)
Actuality. Currently, with extensive narrowing of the ureter, operations such as replacement with a segment of the small intestine and kidney autotransplantation are more often performed. However, these operations are technically complex with a high percentage of various complications. With narrowing of the proximal ureter, when it is not possible to perform uretero-ureteroanastomosis, an alternative may be a replacement by buccal mucosa grath (BMG). Materials and methods. Reconstructive surgeries with BMG in patients with extended urethral strictures are widely used. Experimental studiesconducted in the 80s showed the possibility of replacing the narrowed portion of the ureter by BMG. Subsequently, publications appeared on the results of such operations in clinical practice. Ureter buccal surgery is performed using open, laparoscopic and robot-assisted accesses. The average length of strictures according to various authors ranged from 3 to 11 cm. Most often, the operation was used according to the onlay technique, when a narrowed area was distinguished, a ureter was opened over the length and BMG was sewn. The technique of forming a tubular flap from a buccal grath to replace the ureter defect is described. Results.According to online literature, ureteroplasty by BMGis associatedwith 11%, and tubular ureteroplastywith 45% recurrence of ureteralstricture, which is associated with insufficient vascularization of the flap. Recent reports on BMG ureteroplasty have not only focused on evaluating results, but also have focused on improving surgical techniques. Publications has appeared in the literature on robot-assisted buccal ureteroplasty with good results. Conclusion. Thus, buccal ureteroplasty may be the method of choice in patients with extended strictures of the proximal ureter. This operation is not technically difficult because of the possibility of cutting out the BMG of the desired length and the lack of the need for wide mobilization of the ureter for subsequent replacement.