Segmental ureteric replacement: An animal study using a free non-pedicled graft

Abstract

An animal study has been carried out on 3 baboons to assess the feasibility of replacing a damaged segment of ureter with a free, non-pedicled, full thickness graft. A 3 cm segment was excised from the middle third of one ureter from each baboon and the free graft (buccal mucosa) fashioned into a tube and interposed between the cut ends in order to replace the excised segment. The grafts were left in situ for up to 10 weeks and their subsequent fate studied radiologically, histologically and by gross specimen examination. The results showed that in all cases perfect viability of the graft was maintained and there was no evidence of graft shrinkage or of loss of patency. In one instance a stricture developed at the mid point of the graft, but this was entirely explicable on technical grounds. Urine drainage was not impaired on account of the insertion of a muscle-free (and therefore aperistaltic) segment into the ureter.

Treatment of long ureteric strictures with buccal mucosal grafts

“…This innovative technique, like the classic Davis intubated ureterostomy, has the capacity to treat strictures up to 10–12 cm in length, but avoids the prolonged postoperative urinary leakage and 6‐week period of stenting associated with this procedure and does not depend on the capability of damaged urothelium to regenerate [8]. In experimental animals that underwent partial ureteric segment resection, buccal mucosal interposition grafts took well and provided good drainage of the upper urinary tract [9].…”

Histological and Urographic Findings in the Autotransplanted Ureter without Kidney in Dogs: Preliminary Report

“…Segments of fallopian tube [6], bladder mucosa [7], fragments of renal pelvis [8] or buccal mucosa [9] had been used as free grafts with variable degrees of success. Harvard et al [10] used 1 cm of autologous and homolo gous lyophilized ureter with little success.…”

Outcomes of robotic‐assisted laparoscopic upper urinary tract reconstruction: 250 consecutive patients

“…Others had previously reported using buccal grafts for ureteroplasty in open surgery . The use of oral mucosal segmental ureteric replacement was first reported in an animal model in 1984 . The implications of adding oral mucosal graft ureteroplasty to our armamentarium are vast.…”