Endourological management of benign ureteral stricture: Less is more?

Colicchia, Michele; Beltrami, P.; Soligo, Matteo; Bettin, L.; Berto, Cesar G.; Iafrate, Massimo; Moro, Fabrizio Dal; Zattoni, Fabio

doi:10.1016/s1569-9056(19)31062-0

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“…Ureteral strictures can be classified into proximal, middle, and distal ureteral strictures; panureteral strictures; and ureteropelvic junction obstruction (UPJO), according to the sites of stricture [ 4 ]. Short-segment strictures of the proximal and middle ureter are usually reconstructed by endourological management or surgical operations involving primary excision and end-to-end anastomosis either in the form of pyeloureteroplasty or ureteroureterostomy [ 5 , 6 ]. If a longer segment stricture is present, more advanced surgical techniques, such as renal mobilization and downward nephropexy, ileal ureter replacement, transureteroureterostomy, and autotransplantation of the kidney, are necessary to provide a tension-free anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review

Xiong

Wang

Zhu

et al. 2020

BioMed Research International

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Ureteroplasty using onlay grafts or flaps emerged as an innovative procedure for the management of proximal and midureteral strictures. Autologous grafts or flaps used commonly in ureteroplasty include the oral mucosae, bladder mucosae, ileal mucosae, and appendiceal mucosae. Oral mucosa grafts, especially buccal mucosa grafts (BMGs), have gained wide acceptance as a graft choice for ureteroplasty. The reported length of BMG ureteroplasty ranged from 1.5 to 11 cm with success rates of 71.4%-100%. However, several studies have demonstrated that ureteroplasty using lingual mucosa grafts yields better recipient site outcomes and fewer donor site complications than that using BMGs. In addition, there is no essential difference in the efficacy and complication rates of BMG ureteroplasty using an anterior approach or a posterior approach. Intestinal graft or flap ureteroplasty was also reported. And the reported length of ileal or appendiceal flap ureteroplasty ranged from 1 to 8 cm with success rates of 75%-100%. Moreover, the bladder mucosa, renal pelvis wall, and penile/preputial skin have also been reported to be used for ureteroplasty and have achieved satisfactory outcomes, but each graft or flap has unique advantages and potential problems. Tissue engineering-based ureteroplasty through the implantation of patched scaffolds, such as the small intestine submucosa, with or without cell seeding, has induced successful ureteral regeneration structurally close to that of the native ureter and has resulted in good functional outcomes in animal models.

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Section: Introductionmentioning

confidence: 99%