Oral mucosal graft ureteroplasty versus ileal ureteric replacement: a meta‐analysis

Abstract

ObjectivesTo describe outcomes of oral mucosal graft ureteroplasty (OMGU) and ileal ureter replacement (IUR) and determine the relative merits of both procedures. MethodsDatabases (including PubMed, Embase and Cochrane) were interrogated for eligible trials that assessed outcomes of OMGU or IUR from 2000 to 30 July 2022. The variables analysed were reconstruction success rates, stricture length, hospital stays, perioperative complications and long-term complications. ResultsA total of 23 single-arm studies were included. The pooled reconstruction success rates for OMGU and IUR were 94.9% (95% confidence interval [CI] 91.0%-97.7%) and 85.8% (95% CI 81.0%-90.0%), respectively. Stricture length of patients in the OMGU and IUR groups were 3.73 (95% CI 3.17-4.28) and 11.55 (95% CI 9.82-13.29) cm, respectively. The maximal stricture length repaired by OMGU was 8 cm. The hospital stays were 5.85 (95% CI 3.88-7.82) and 11.55 (95% CI 6.93-16.17) days in the OMGU and IUR groups, respectively. The incidences of low-grade postoperative complications were 13.6% (95% CI 6.9%-20.3%) and 27.3% (95% CI 19.5%-35.1%), high-grade postoperative complications were 4.6% (95% CI 1.8I-8.5%) and 13.0% (95% CI 9.4%-17.1%), and long-term complications (occurred at > 3months) were 9.0% (95% CI 1.7%-20.0%) and 35.4% (95% CI 25.8%-45.6%) in the OMGU and IUR groups, respectively. ConclusionAn OMGU is an effective, minimally invasive, and safe alternative to IUR for the management of long ureteric strictures. OMGU was the preferred treatment for long ureteric strictures, especially obstructed ureter segments of ≤8 cm.

Ureteroplasty with buccal mucosa graft without omental wrap: an effective method to treat ureteral strictures

“…In contrast to this, none of our patients had complications at the BMG donor site, two had a postoperative UTI, and one patient had an incision hernia approximately one year after the procedure. A recent meta-analysis of OMG ureteroplasty versus ileal ureteric replacement by You et al supports these findings of lower complication rates and less severe complications for OMGs opposed to intestinal interposition [ 11 ]. The technique described in this study uses an onlay approach.…”

“…Intestinal interposition bears many risks including bowel anastomosis leakage, impaired bowel movement or ileus, mucus obstruction of the urinary tract, and recurrent urinary tract infections (UTI) [ 11 , 15 ]. Additionally, the long-term exposure of urine to ileal mucosa presents a risk for the development of metabolic acidosis [ 15 ].…”

“…Since 2016, OMGs are recommended as the first choice for urethral reconstruction with graft tissue in the guidelines of the American Urological Association (AUA) [ 10 ]. Due to the feasibility of OMGs, promising outcomes, and low rate of complications, there has been increased interest in OMG for ureteroplasty [ 11 ]. However, the European Association of Urology (EAU) guidelines for urological trauma have recently added the specification “oral” graft since the 2022 version, placing it as an equal option to autotransplantation and intestinal interposition [ 12 ].…”

“…However, the European Association of Urology (EAU) guidelines for urological trauma have recently added the specification “oral” graft since the 2022 version, placing it as an equal option to autotransplantation and intestinal interposition [ 12 ]. Compared to intestinal interposition, OMG has shown superior results regarding complication and success rates [ 11 ]. BMG is an ideal tissue for ureter reconstruction due to its properties including its resistance to infection, compatibility with a wet environment and hairlessness.…”

Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes

“…The treatment of long proximal ureteral stricture (US) remains a challenge for urologists. Since the first case of laparoscopic lingual mucosal graft ureteroplasty (LMGU) was introduced by Li et al in 2015 ( 1 ), it received extensive attention as an efficient way to avoid ileal ureter replacement or renal autotransplantation for ureteral reconstruction ( 2 ). Recently, Yang et al reported the technique and initial experience of robotic LMGU with encouraging perioperative and medium-term follow-up outcome ( 3 ).…”