Muco-mucosal anastomotic non-transecting augmentation (MANTA) ureteroplasty

Revision ureteric reconstruction is often very challenging due to limited ureteric length and compromised blood supply. We aimed to describe a technique of a non-transecting augmentation ureteroplasty with buccal mucosal graft for a patient with a recurrent ureteric stricture. This technique was adapted from the urethroplasty literature and applied to upper tract reconstruction. A 70 year old male had previously underwent a diverticulectomy and boari flap reimplantation for urothelial cancer. The anastomosis strictured and a revision ureteric reimplantation was performed which also subsequently strictured. A stent was not able to be placed across the stricture so the patient was nephrostomy dependent. A buccal mucosal graft augmentation was performed using a muco-mucosal anastomotic non-transecting augmentation (MANTA) technique adapted from the urethroplasty literature The patient recovered well and was discharged day 3. A cystogram was performed and catheter removed at 4 weeks. The stent was removed at 6 weeks and a retrograde pyelogram showed a normal ureteric caliber. A MAG-3 renogram at 3 months showed no obstruction We describe a novel technique for difficult revision upper tract reconstruction cases.