Onlay Graft Research Articles

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Simultaneous Coronoid Bone Grafting in Ballistic Facial Trauma Patients Undergoing Coronoidectomy.

Ballistic facial trauma can cause complex fractures and overlying soft tissue damage, with a zone of injury that extends beyond the bullet tract. Early skeletal fixation is indicated, and previous large case series describe the use of debrided bone fragments as 'spare part' grafts. This series presents the indications and techniques for simultaneous coronoid bone grafting in 2 patients who sustained a gunshot wound to the right midface and required coronoidectomy. The coronoid process was used as (1) an interposition graft in the lateral buttress of the right maxilla for stability, and (2) an onlay graft on the right inferior orbital rim for contour. Both patients did not have graft infection, extrusion, or malposition at the 1-month clinic follow-up. The coronoid process of the mandible is a viable, safe spare-part option, despite the possible location of the coronoid process within the zone of injury in the reconstruction of complex ballistic facial trauma.

A novel technique for skull base reconstruction in craniofacial fibrous dysplasia surgery using three-dimensional printing and a dental alginate mold: illustrative case.

Fibrous dysplasia is a rare and benign skeletal lesion characterized by fibrous tissue proliferation due to an abnormal osteogenesis replacing normal bone. An 18-year-old male with fibrous dysplasia of the left sphenoid, ethmoid, orbit, and frontal bones was managed with excision and skull base reconstruction. After complete removal of the tumor, skull base reconstruction was commenced by making a reverse temporalis flap and placing it over the opened paranasal sinuses for a robust vascularized graft, followed by an abdominal fat graft, and then a pedicled pericranal flap was added to complete the multilayer onlay graft. To recreate the skull base, a mirror image of the contralateral skull base was constructed using three-dimensional (3D) printing, and the 3D-printed model was sterilized prior to the surgery. Intraoperatively, the model was then pressed onto dental alginate gel to make a negative mold. This was used to make the definitive flap using polymethylmethacrylate. Temporoplasty was also performed using polymethylmethacrylate to fill the defect left by the temporalis graft. The patient recovered well following the procedure. Appropriate, personalized skull base reconstruction techniques can be successfully done with 3D printing using alternative low-cost materials and implements, especially following resection of cases like craniofacial fibrous dysplasia. https://thejns.org/doi/10.3171/CASE24262.

A Case of Nasoseptal Flap Reconstruction for Refractory Medial Canthal Fistula.

Sino-orbital cutaneous fistulas (SOCFs) are a rare and challenging complication from conditions including granulomatosis with polyangiitis. SOCFs are difficult to manage due to poor vascular supply, compromised tissue, and systemic immunocompromise, which lead to a high rate of recurrence. Given the overall rarity of SOCFs, optimal surgical repair remains controversial, with options ranging from conservative management, onlay grafts, and vascularized flaps. This case report describes a novel one-step approach to SOCF closure using a composite chondral mucosal nasoseptal flap in a patient with a large left medial canthal SOCF that had recurred despite 2 prior attempts at closure including a vascularized paramedian forehead flap. Nasoseptal flaps may provide vascularized mucosal tissue to allow for greater success in closure over traditional, external flaps, and skin grafts.

Clinical Implementation of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges.

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement coding. Technological advancement: The tissue-sparing posterior cervical fusion procedure was approved by the US Food and Drug Administration (FDA) in 2018 (CORUS™ Spinal System and CAVUX® Facet Fixation System (CORUS/CAVUX); Providence™ Medical Technology). This technique addresses the concerns with traditional spine fusion methods by achieving the stability and outcomes of posterior cervical fusion without the morbidity associated with significant muscle stripping in the traditional approach. This technology uses specialized implants and instrumentation to perform all of the steps required to facilitate bone fusion and provide stability while minimizing tissue disruption. The technique involves extensive bone preparation for fusion and placement of specialized stabilization implants that span the facet joint, promoting natural bone growth and fusion while reducing the need for extensive exposure. This procedure provides an effective, less invasive solution for patients with cervical degenerative disc disease. Reimbursement and coding clarity: The article provides a comprehensive rationale for appropriate reimbursement coding for tissue-sparing posterior cervical fusion. This is a critical aspect for the adoption and accessibility of medical technologies. This information is crucial for practitioners and healthcare administrators, ensuring that innovative procedures are accurately coded and reimbursed. Procedural details and clinical evidence: By detailing the procedural steps, instruments used and the physiological basis for the procedure, this article serves as a valuable educational resource for spine surgeons and payers to appropriately code for this procedure. Conclusions: The description of work for CORUS/CAVUX is equivalent to the current surgical standard of lateral mass screw fixation with decortication and onlay posterior grafting to facilitate posterior fusion. Thus, it is recommended that CPT codes 22600/22840 be used, as they best reflect the surgical approach, instrumentation, decortication, posterior cervical fusion and bone grafting procedures.

A literature review of current surgical treatment for congenital pseudoarthrosis of the tibia

Congenital pseudarthrosis of the tibia (CPT) is an infrequently observed condition. However, it is considered to be one of the most complex ailments in the field of pediatric orthopedics. In cases where a tibial fracture is absent, the conventional treatment approach involves using bracing as a preventive measure against fractures. Various surgical modalities have been proposed for the management of CPT, including intramedullary (IM) rod fixation, external fixators, on-lay grafts, cancellous grafts, periosteal grafts, Paley cross-union, amputation, vascularized fibula grafts, and induced membrane techniques. These modalities can be used in different combinations and permutations. The need for repetitive surgical interventions due to unsuccessful therapeutic outcomes or modifications in secondary treatments can significantly disrupt the childhood experience, resulting in prolonged and recurrent functional limitations. In certain instances, amputation may be required as a primary or secondary treatment modality. This literature review will clarify the current surgical interventions for CPT disease based on a summary of research data. The surgery the patient receives significantly impacts their general health and capacity to heal.

Application of autogenous block bone graft in the reconstruction of severe alveolar crest defect

Patients with severe alveolar ridge defects cannot be directly implanted and repaired, which seriously affects their quality of life. Onlay bone grafting is the main solution for severe alveolar ridge bone defect reconstruction, among which autogenous block bone grafting is the most widely used and is also the focus of clinical research on bone tissue reconstruction. This article expounds the characteristics and basic principles of autogenous bone block grafting, and comprehensively analyzes the selection of autogenous bone donor site, the principles of surgical operation, and the progress of bone graft techniques. In order to help surgeons make correct clinical decisions, increase the predictability of surgical effects, and improve the level of clinical diagnosis and treatment.

Long-Term Results Using “Nair Hospital Precision Carving” Technique of Rhinoplasty

Abstract Background and Objectives Convincing a patient who has undergone any aesthetic surgery to come for a long-term follow-up is extremely difficult. The result obtained after rhinoplasty usually stabilizes in the first year and it is unlikely to change after 2 years. The precision carving technique described in 2014 has been employed by us for the last several years. We wish to present long-term results (at least 2 years) obtained using this technique, now renamed as “Nair Hospital Precision Carving technique.” The unfavorable effects of warping are most apparent in the dorsum. So, we have chosen to assess results of dorsal onlay grafts only. This article presents the long-term results obtained using favorable warping technique. Materials and Methods We have followed up 45 patients in whom dorsal augmentation was done using rib grafts for various indications like aesthetic, reconstructive rhinoplasty and cleft lip nasal deformity. Grafts were carved using the precision carving technique. Results All patients were assessed at 6 weeks, 6 months, and at subsequent follow-up period of 2 to 10 years and photographs were taken at each visit. There was no major complication and all patients were satisfied with the appearance. Conclusion The Nair Hospital Precision Carving technique utilizes unbalanced yet controlled and precise carving to achieve a variety of natural shapes for the objectives of contour fill and framework reconstruction in rhinoplasty, thus ensuring good long-term results.

Substitution Urethroplasty With Buccal Mucosal Graft in the Management of Stricture of Vesicourethral Anastomosis or Membranous Urethra: Single-institution Long-term Experience With Perineal Approach and Endourethroplasty

ObjectiveTo present long-term experience with buccal mucosa posterior urethroplasty (BMPU) for refractory posterior urethral stenosis (PUS) or vesicourethral anastomosis stenosis (VUAS) either by perineal approach (PA) or by endourethroplasty (EUP). Materials and MethodsA single-center retrospective study of 38 consecutive patients operated on between 1999 and 2022. BMPU consisted of the transfer of onlay or tubular buccal mucosa grafts into dilated and/or incised strictures through an open or endourological approach. If VUAS or PUS recurred with short stenosis within the first 12 months after surgery, it was transected by a cold-knife direct vision internal urethrotomy (DVIU), referred to as an ‘auxiliary’ DVIU. The primary outcome was three-year stricture recurrence-free survival (SRFS). ResultsBMPU by perineal approach and EUP were performed in 27 (71%) and 11 (29%) patients, respectively. The three-year SRFS was 65% for the whole cohort, with rates of 63% for the perineal approach and 73% for endourological approach. With permitted auxiliary DVIU, three-year SRFS for the whole cohort was 81%. De novo incontinence occurred in 2 out of 18 preoperatively continent patients. Limitations include the retrospective nature of the single-center study and a small, heterogenous cohort of patients. ConclusionsWe present two techniques of substitution urethroplasty with BMG in the management of PUS and VUAS with a low rate of recurrence or de novo incontinence. A novel endourological approach (EUP) is a promising minimally invasive alternative to the perineal approach.

Quantitative Evaluation of Zygomatic Buttress, Ramal, and Symphysis Onlay Grafts in Ridge Augmentation Prior to Implant Placement

Quantitative Evaluation of Zygomatic Buttress, Ramal, and Symphysis Onlay Grafts in Ridge Augmentation Prior to Implant Placement

The influence of bone block graft position on bone dimensional changes in staged onlay horizontal ridge augmentation: A 6-month retrospective cohort study.

To analyze changes in bone dimensions and their modulating factor in bone dimensions 6 months after horizontal ridge augmentation using autogenous bone grafts. Thirty-eight patients with horizontally atrophic alveolar ridges of a single edentulous tooth at the maxillary anterior site were divided into two groups based on the fixation position of the bone block during ridge augmentation surgery (H0, vertical distance from the upper edge of the bone block to the alveolar crest). Patients were classified into a crestal level (CL) group if H0 ≤ 1 mm and a sub-crestal level (SCL) group if H0 > 1 mm. The width and height of the alveolar ridge were recorded using CBCT both before and 6 months after the augmentation procedure. The CL group comprised 20 patients with 23 implants, whereas the SCL group comprised 18 patients with 22 implants. All the augmentation sites exhibited vertical bone resorption. Vertical bone resorption in the SCL group (1.94 ± 2.11 mm) was significantly higher than that of the CL group (0.61 ± 0.64 mm). The SCL group showed significantly lower horizontal bone gain than the CL group (SCL: 1.02 ± 2.30 mm; CL: 3.19 ± 3.17 mm) at the cervical level. Peri-implant marginal bone loss increased significantly in the SCL group (1.00 ± 2.71 mm) compared to the CL group (0.64 ± 0.40 mm). The bone height decreased after horizontal ridge augmentation using autogenous onlay grafting. The fixation position of the bone block was a modulating factor. The SCL group showed more vertical bone loss, less horizontal bone gain 6 months after surgery, and more marginal bone loss after restoration.

Uretroplastia femenina con injerto de mucosa oral en una etapa: resultados comunicados por las pacientes y tasas de éxito funcional a largo plazo

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, improvement in maximum flow rate) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83 and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25 and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate was 10ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Long-term functional success and patient-reported outcomes after female one-stage buccal mucosal graft urethroplasty

Introduction and objectivesFemale urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center. Patients and methodsWe conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes). ResultsOf 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction. ConclusionsBuccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

Use of lateral alar caudal graft to increase nasal tip definition in rhinoplasty

ObjectiveThe aim of this study is to demonstrate use of Lateral Alar Caudal Graft to increase nasal tip definition in primary or revision rhinoplasty cases. MethodLateral Alar Caudal Graft was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023 years. Fourteen of the patients were female and 10 were male. This technique was applied in revision or primary cases where the caudal part of the lateral alar crura of the lower lateral cartilage was lower in the vertical plane than the cephalic part. The Lateral Alar Caudal Graft was sutured over the caudal edge of the lateral alar crura of the lower lateral cartilage. ResultThe mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. ConclusionWe have successfully demonstrated that in primary or revision rhinoplasty cases, nasal tip definition will be enhanced by positioning the caudal level of the lateral alar crura of the lower lateral cartilage higher than the cephalic level using an onlay lateral alar crural graft and eliminated the need for alar rim graft.

Cortical Block Grafting Successfully Augments Alveolar Cleft Sites for Dental Implant Placement

BackgroundSupplemental bone grafting is regularly required before dental implant placement in patients with cleft lip and palate (CLP). PurposeThe study purpose was to measure and compare implant osseointegration and changes in graft dimensions following lateral incisor onlay cortical bone grafting in CLP and non-CLP patients. Study design, setting, sampleRetrospective cohort study composed of patients who presented to Boston Children’s Hospital and underwent autogenous onlay cortical block bone grafting at lateral incisor sites from 2015 through 2023. Patients were excluded if the cone beam computed tomography (CBCT) quality was insufficient for accurate measurements. Predictor variableThe predictor variable was CLP status coded as CLP or non-CLP. Main outcome variableThe primary outcome variable was successful implant osseointegration confirmed by a torque of 35 N/cm or more after 3 months of implant healing. Secondary outcomes were change in bone width between pre- and post-operative CBCT scans at lateral incisor sites and the need for additional bone augmentation prior to or during implant placement. CovariatesCovariates were age, sex, cleft location, and time from bone graft to postoperative CBCT and implant placement. AnalysesData analyses were performed using T-tests, Fisher’s Exact Tests, Mann-Whitney U Tests, and Pearson’s correlation. P<0.05 was considered statistically significant. ResultsA total of 22 subjects (16 with CLP) were evaluated. The mean age at the time of graft was 19.3 ± 2.4 years with 52.6% males. Implants osseointegrated at 20 of 22 lateral incisor sites (one CLP failure, one non-CLP failure). There was significant change in bone width after grafting for patients with CLP (p<0.001). Patients with CLP experienced a 3.32 (± 1.80) mm and 2.99 (± 1.61) mm increase in bone width at two different levels. Patients with CLP achieved greater boney changes near the alveolar crest than non-cleft patients (p=0.008) but the change was not significantly different more apically (p=0.86). One subject with CLP required additional grafting during implant placement. Conclusions and RelevanceCortical block onlay bone grafting is a predictable technique to augment lateral incisor sites in patients with cleft lip and palate for placement of a dental implant.

Surgical Outcomes of Laminectomy, Durotomy and a Non-Synthetic Dura Substitute Application in Ten Dogs with a Spinal Subarachnoid Diverticulum.

This retrospective study aimed to report the surgical treatment and outcomes of laminectomies followed by durotomy and the application of a non-synthetic collagen matrix dura substitute (DurepairTM) in ten dogs with a spinal subarachnoid diverticulum (SAD). The medical records of these ten client-owned dogs with SAD diagnosed by magnetic resonance imaging (MRI) were reviewed. All patients had chronic and progressive deficits. At presentation, common neurological signs were proprioceptive ataxia, ambulatory spastic paraparesis or tetraparesis, and faecal incontinence. Dorsal thoracolumbar laminectomy was performed in eight dogs; one dog underwent cervical dorsolateral laminectomy, and one patient had thoracic hemilaminectomy. Laminectomies were followed by durotomy, allowing the dissection of the pia-arachnoid adhesions. A rectangular patch of a non-synthetic dura substitute was applied as an onlay graft over the durotomy site before routine closure. Proprioceptive ataxia, paraparesis, and tetraparesis improved in all patients. Faecal incontinence in one patient resolved postoperatively. Laminectomy, durotomy, and the application of a non-synthetic dura substitute was a safe procedure facilitating postoperative improvement over a long-term follow-up period (from 9 to 40 months).

Histological analysis of bone grafts fixed with ethyl‐cyanoacrylate and fixed with titanium screw: An experimental study on rats

AbstractObjectivesThe aim of this study was to evaluate, through qualitative and semi‐quantitative histological analysis, onlay autologous bone grafts fixed with ethyl‐cyanoacrylate adhesive and titanium screw, in order to verify whether the method of applying the adhesive would interfere with the graft incorporation.Materials and MethodsFourteen rats underwent bone graft surgery: seven grafts were fixed with ethyl‐cyanoacrylate (SB group, n = 7) and seven grafts were fixed with titanium screws (TS group, n = 7). After 30 days, the grafts were histologically analysed for vitality, adhesive presence, tissue reaction with formation of osteoid matrix, bone resorption presence, capillaries formation, inflammatory infiltrate, fibroblastic proliferation, presence of osteoblasts, osteocytes and osteoclasts. The data were submitted to non‐parametric tests, Mann–Whitney, Fisher's Test, Wilcoxon and McNemar and to statistical analysis (p &lt; 0.05).ResultsNo significant differences were found in the qualitative evaluations. While findings of more osteocytes (p = 0.035) in the TS group in greater inflammation (p = 0.030) and more osteoclasts (p = 0.048) in the SB. Despite the fact that the titanium screw has presented bone neoformation with welding points, there was no complete incorporation and the adhesive affected the bone repair in a way that not even neoformation points could be seen in 30 days.ConclusionThe method of applying the adhesive did not show an advantage according to the histological aspects studied, as there was the formation of a dead space at the interface of the SB group and the adhesive acted as a barrier.

3D-printed bredigite scaffolds with ordered arrangement structures promote bone regeneration by inducing macrophage polarization in onlay grafts

Bone tissue engineering scaffolds may provide a potential strategy for onlay bone grafts for oral implants. For determining the fate of scaffold biomaterials and osteogenesis effects, the host immune response is crucial. In the present study, bredigite (BRT) bioceramic scaffolds with an ordered arrangement structure (BRT-O) and a random morphology (BRT-R) were fabricated. The physicochemical properties of scaffolds were first characterized by scanning electron microscopy, mechanical test and micro-Fourier transform infrared spectroscopy. In addition, their osteogenic and immunomodulatory properties in an onlay grafting model were investigated. In vitro, the BRT-O scaffolds facilitated the macrophage polarization towards a pro-regenerative M2 phenotype, which subsequently facilitated the migration and osteogenic differentiation of bone marrow-derived mesenchymal stem cells. In vivo, an onlay grafting model was successfully established in the cranium of rabbits. In addition, the BRT-O scaffolds grafted on rabbit cranium promoted bone regeneration and CD68 + CD206 + M2 macrophage polarization. In conclusion, the 3D-printed BRT-O scaffold presents as a promising scaffold biomaterial for onlay grafts by regulating the local immune microenvironment.Graphical

Treating Multifocal Ureteral Strictures with Combined Techniques: 14 Cases of Initial Experience.

Purpose: To evaluate the safety and feasibility of lingual mucosal graft ureteroplasty (LMGU) combined with ureteral reimplantation (UR) for repairing managing multifocal ureteral strictures (MUS). Methods: Between December 2020 and December 2022, 14 patients underwent LMGU combined with UR. Their perioperative data were collected retrospectively and analyzed. For the proximal diseased ureter, the narrow segment was incised longitudinally to open the ventral wall of ureter, and a lingual mucosal graft was placed as an onlay graft. Meanwhile, UR was applied to treat distal ureteral strictures. Results: Of 14 patients, three (21.4%) had previously undergone a failed ureteral reconstruction. The mean (standard deviation [SD]) proximal stricture length was 4.0 cm (1.56), and distal ureteral stricture length was 4.3 cm (0.94). The mean (SD) operative time was 236 minutes (57), the estimated blood loss was 78 mL (41.5), and the length of postoperative stay was 6 days. One (7%) patient underwent double LMGU to treat proximal 2 segments of ureteral stricture. No open conversions and intraoperative complications occurred. With a mean follow-up of 15 months (range 6-29), the recurrence-free rate was 14/14 (100%). Conclusions: LMGU combined with UR is a feasible and effective technique for managing MUS and can be an alternative to ileal ureteral replacement or renal autotransplantation in some selected patients with MUS.

Robot-Assisted Ureteroplasty with Labial Mucosal Onlay Grafting for Long Left-Sided Proximal Ureteral Stenosis in Children and Adolescents: Technical Tips and Functional Outcomes.

Purpose: To evaluate functional outcomes of robot-assisted ureteroplasty with labial mucosa grafting for long proximal ureteral stenosis (LPUS) in children and adolescents. Methods: Included in this study were 15 patients who underwent robot-assisted ureteroplasty with labial mucosal grafting in our center between July 2017 and September 2021. The left affected stenotic ureter was repaired using labial mucosal grafting. If the ureter was simply strictured but not obliterated, the ureter was spatulated longitudinally along the ventral side and the labial mucosa graft was interposed and anastomosed in a continuous manner. Faced with the obliterated segment, it was excised and the spatulated portion re-anastomosed with a pelvic flap as the dorsal wall. The labial mucosa graft was placed as the ventral wall. The preoperative clinical data and follow-up outcomes were collected and evaluated. Results: Labial mucosa graft onlay ureteroplasty was well performed in all the 15 patients with no occurrence of intraoperative complications or surgical conversion. Five patients underwent an onlay ureteroplasty, and 10 patients underwent a dorsally augmented pelvic flap anastomotic ureteroplasty. The mean (range) stricture length was 7.1 (3-10) cm. The mean operative time was 371.2 (216-480) minutes, and the median blood loss was 40 mL. At the median follow-up of 35 months (range 12-58 months), the overall success rate was 93.3%. Conclusions: Labial mucosa grafting appears to be safe and feasible for repairing long ureteral strictures in pediatric and adolescent patients. Our experience may provide beneficial references and conveniences to solve complex problems in LPUS. This study was approved by the institutional review board, and written informed consent was obtained from each participant (ethics number: 2017-30).