Treatment of extensive ureteral strictures is always a surgical challenge. The ureteroplasty with buccal mucosa graft is an interesting option when the stenosis involves the proximal or medial portion of the ureter.
The objective of this video was to present an ureteroplasty technique.

We present the case of Mr, 47 years old. His has an ureteral stricture after an ureteroscopy for ureteral stones. Following this surgery, he developed an ureteral stenosis, which was initially treated by ureteral catheterization.
After the removal of the ureteral stent, he got a recurrence of the stricture.
The ureteroscopy and the ureteral opacification showed a complete ureteral obliteration on 7 cm. He had the placement of a nephrostomy tube, and we proposed him to do an ureteral reconstruction, depending of the per operative findings.

The patient is placed in the Egyptian position, with an access to the right nephrostomy tube. We start by placing the five ports.
The right ureter is located and dissected. We started by dissection the junction between the ureter and the pelvic kidney. 
Firefly fluorescence with intravenous injection of indocyanine green is used to visualize the ureteral vascularization. We opened the stenotic ureter at its anterior side, with a per operative ureteroscopy using the nephrostomy tube to visualize the ending of the stricture.  The non-vascular portion of the ureter is excised. 

The anastomosis was in tension, and we completed the gesture using a nephropexy by freeing the kidney from his posterior peritoneal attachments. 

Then we did the anastomosis, starting by its posterior aspect and using the buccal mucosa graft to do the anterior side. The anastomosis was protected by the placement of a JJ stent. 

The operative time was 260 minutes with minimal blood loss. There was no postoperative complication. 
The nephrostomy tube was removed at post-operative day 2 and the endoureteral catheter at 6 weeks.

Using a buccal mucosa graft can help us to do an ureteroplasty for extended ureteral stricture. Depending on the per operative findings, a nephropexy can help us to complete the anastomosis if the stricture is too long.

Continence 7S1 (2023) 100797
DOI: 10.1016/j.cont.2023.100797