Introduction: The two main approaches utilized in buccal mucosa graft ureteroplasty for surgical management of ureteral strictures include the onlay and augmented anastomotic techniques. We describe the decision-making process and surgical technique for each approach. Methods: We demonstrate the case of a patient with bilateral ureteral strictures who underwent multiple prior ureteroscopic stone procedures and a failed left dismembered pyeloplasty. The patient underwent an augmented anastomotic buccal mucosa graft ureteroplasty for a right sided obliterated stricture and an onlay buccal mucosa graft ureteroplasty for a left sided narrowed stricture. Table 1 demonstrates perioperative data from the Collaborative of Reconstructive Robotic Ureteral Stricture database for each technique. Results: The surgical technique utilized for buccal mucosa graft ureteroplasty depends on stricture quality, which include narrowed versus obliterated characteristics. An onlay technique is the preferred approach for narrowed strictures, while an augmented anastomotic technique is the preferred approach for obliterated strictures. Surgical success was demonstrated in 92.3% and 84.6% of patients undergoing an onlay versus augmented anastomotic technique, respectively. Conclusions: In patients undergoing buccal mucosa graft ureteroplasty, stricture quality is an important factor involved in the decision-making process when choosing to perform an onlay versus augmented anastomotic approach. SOURCE OF Funding: None
