Buccal Mucosal Graft for Onlay Ureteroplasty in the Management of Proximal Ureteral Stricture

Study Overview
=================
Brief Summary
-----------------
Onlay uretroplasty with either grafts or flaps has been attempted by many reconstructive urologists, ln particular buccal mucosa graft (BMG) ureteroplasty has been reported by many centers and has shown its feasibility and safety

Detailed Description
-----------------
In cases of long segment upper ureteral stricture, more advanced surgical techniques, such as renal mobilization and downward nephropexy, ileal ureter replacement, transureteroureterostomy, and autotransplantation of the kidney, are necessary to provide a tension-free anastomosis. Autotransplantation of the kidney needs more efforts, more experts and may lead to significant renovascular complications. Also, there is severe metabolic and intestinal complications are associated with using of long intestinal segment in the management of ureteral stricture [9]. These previous side effects and difficulties make the management of long upper and middle ureteral strictures more complicated and indicate other lines of management urgently. Even the ureteral stricture still not patent enough to drain urine but still, we can use it as a ureteral plate with little affection of its vascularity. Based on this theory an onlay repair technique was emerged. Onlay uretroplasty with either grafts or flaps has been attempted by many reconstructive urologists, ln particular buccal mucosa graft (BMG) ureteroplasty has been reported by many centers and has shown its feasibility and safety.

Official Title
-----------------
Buccal Mucosal Graft for Onlay Ureteroplasty in the Management of Proximal Ureteral Stricture

Conditions
-----------------
Stricture Ureter

Intervention / Treatment
-----------------
* Procedure: Buccal mucosa for proximal ureter stricture


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Proximal ureteral stricture or uretropelvic junction obstruction (UPJO) which are not amenable for primery anastmosis. Exclusion Criteria: Buccal graft contraindications as i. Active oral infections ii.Oral cancers like cancers of lips, tongue or cheeks.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Patients with inclusion criteria of uretral stricture will be treated with open uretroplasty with buccal graft and omental wrapping
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Buccal mucosa graft for ureteral stricture<br>Patients with inclusion criteria of ureteral stricture will be treated with open ureteroplasty with buccal graft and omental wrapping. | Procedure: Buccal mucosa for proximal ureter stricture<br>* Patients with inclusion criteria of uretral stricture will be treated with open uretroplasty with buccal graft and omental wrapping<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Restoration of ureteric patency. | Restoration of ureteric patency as assessed by contrast study (intravenous urography) and ureteroscope. | 6 months post-operative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain relief after surgery | Relief of pain measured by Visual Analog Score for pain | 6 months post-operative | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Buccal mucosa, Stricture, ureteroplasty