Review Article

Onlay Repair Technique for the Management of Ureteral Strictures: A Comprehensive Review

Table 4

Characteristics of the reported autologous patch grafts for ureteroplasty.

DraftsAdvantagesDisadvantages

Buccal mucosa graftEasy to harvest and handle, tolerance to wet environment, good graft “take”Adversely affected by smoking and betel quid chewing; donor site morbidity such as persistent difficulty with mouth opening and latent parotid duct injury
Lingual mucosa graftEasy to harvest, tolerance to wet environment, obtainable long-segment graft harvesting, good graft “take”, acceptable donor site morbidityThin and relatively hard to handle; potential donor site morbidity such as difficulty with fine motor of the tongue and slurred speech
Ileal mucosa flapMuch less intestine needed than simple replacement, much diminished risk of metabolic derangement and mucous productionMore difficult to harvest and handle; infeasible when ileal inflammation or other diseases occur; potential donor site complications including intestinal anastomotic infection or leak, anastomotic hemorrhage or stenosis, and adhesive or paralytic intestinal obstruction
Appendiceal flapMuch less intestine needed than simple replacement, much diminished risk of metabolic derangement and mucous production, maintaining its own blood supply from the appendicular arteryInfeasible when appendiceal inflammation or calculus occurs; potential donor site complications including intestinal anastomotic leak
Renal pelvis wall graftGrafts close to reconstructed field, similar to the tissue characteristics of the ureterLimited data; limited area of graft harvesting; preferably to reconstruct the obstruction of ureteropelvic junction; large graft harvesting may damage the neuromuscular mechanism of renal pelvis
Bladder mucosa graftObtainable long-segment graft harvesting, tolerance to urine corrosion, and minimized stone formationDonor site morbidity; complications including stricture, hypertrophy, prolapse of the reconstructed site
Penile/preputial skin graftDevoid of hair and fat, easy to harvest and handleLimited data; high recurrence of contracture and restenosis
Vein patch graftEasier to harvest and handle; usually available nearby the spermatic or ovarian veinLimited data; confined to repairing short strictures; complications including fibrosis and restenosis of the reconstructed ureters