Posteriorly Augmented Anastomotic Ureteroplasty with Lingual Mucosal Onlay Grafts: 8-year Multi-institutional Experience in 61 Cases

Background and objective: Management of long proximal ureteral strictures remains a significant challenge. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG) is a novel technique used for treating obliterated or diseased ureteral segments. This study aims to evaluate the long-term effectiveness of PAAU-LMG in a multi-institutional cohort of patients with long, complex proximal ureteral strictures. Methods: This retrospective study involved data for 61 patients treated with PAAU-LMG at three centers between April 2017 and December 2024. Perioperative and follow-up data were collected. Surgical success is defined by the absence of clinical symptoms, no stricture on imaging, and no severe complications. A descriptive statistical analysis was performed. Key findings and limitations: Of the 61 patients, 18 underwent laparoscopic surgery and 43 underwent robotic surgery. PAAU-LMG was performed in 45 (73.77%) cases, 16 (26.23%) cases underwent PAAU-LMG with ureteral dorsal adventitia "fold" technique. The reconstructed ureter was covered with perirenal fat in four cases (6.56%) and with omentum in 57 cases (93.44%). The median (range) stricture length was 3.60 (1.50-9.00) cm, operative time was 140 (84-306) min, estimated blood loss was 50 (10-400) ml, and postoperative hospital stay was 6 (4-10) d. No open conversions and intraoperative complications occurred. At a median (range) follow-up of 32 (7-98) mo, the overall success rate was 100% (61/61). The main limitation is the lack of a control group. Conclusions and clinical implications: PAAU-LMG is a safe, effective, and feasible treatment for selected patients with long obliterated or diseased proximal ureteral strictures. Patient summary: We evaluated the long-term follow-up outcomes of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG), in which the diseased ureter was excised and reanastomosed primarily on the dorsal side, and a lingual mucosal graft was placed on the ventral side. For patients with obliterated or diseased ureter stricture, PAAU-LMG is a safe and feasible alternative with satisfactory outcome.