Robotic buccal mucosal graft ureteroplasty using combination of posterior-inlay and anterior-onlay technique

Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 μmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 μmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.