Use of buccal mucosa graft in robotic-assisted ureteroplasty: experience of a multidisciplinary group in Mexico

Abstract

Introduction: Complex ureteral strictures are challenging, particularly after failed surgery. Buccal mucosa graft ureteroplasty combined with robotic assistance may facilitate precise dissection, preserve periureteral blood supply and minimize manipulation. This paper describes the first experience in ureteral reconstruction with BMG with robotic surgery in a referral center in Mexico.

Materials and methods: Retrospective analysis of 5 patients who underwent robotic BMG ureteroplasty from July 2023 to July 2025.  Patients had upper or mid-ureteral strictures > 3cm and were not candidates for tension free end-to-end repair.  Every intervention was performed by the same team, following a standardized protocol including: use of Indocyanine Green (Intravenous or intraluminal) to identify stricture and vascularization, simultaneous ureteroscopy evaluation and mucosal graft harvesting by a second team. Technique selection- augmented anastomotic ureteroplasty (AAU) vs onlay was based on segment characteristics (luminal obliteration vs narrowing) The follow-up included ultrasound at the 6th week and follow-up on the 6th and 12th months.

Results: Median age was 45 years (36-62 range), female predominance (60 %). Stricture location was ureteropelvic junction in 3 patients (n=3, 60 %), proximal ureter (20 %) and mid-ureter (20 %). 3 patients (60 %) had history of reconstructive surgery. All patients underwent previous ureteral rest. The stricture length was 3.2cm (3-3.5cm range). AAU was performed in (20 %) patients while onlay technique was used in 3 (60 %). We presented 2 early postoperative complications (40 %), Clavien-Dindo I (post-hematoma and urinary tract infection), no major complications. The mean follow-up was 18 months (4-24 range), with no clinical or radiologic recurrence.

Conclusions: Robotic assisted buccal mucosal graft ureteroplasty is an effective and safe technique for ureteral strictures >3cm. Our early results show a 100 % success rate with only mild complications according to the findings on international literature. Larger multicenter cohorts with longer follow-up are warranted to confirm durability and identify predictors of success.