Lingual mucosal graft treatment for recurrent renal bleeding after ureteral stricture surgery: A case report.

RATIONALE

Ureteral stricture is a complex urological condition often requiring surgical intervention. Autologous tissue grafts, such as lingual mucosa, have emerged as a promising option for reconstruction due to their favorable biocompatibility and vascularity. However, reports on complications associated with these techniques remain limited.

PATIENT CONCERNS

A 59-year-old male with a history of bilateral kidney stones, chronic renal failure, hypertension, and multiple prior ureteral surgeries presented with left ureteral obstruction and severe hydronephrosis. He had been on regular dialysis and previously underwent several endoscopic and percutaneous stone procedures.

DIAGNOSES

Preoperative imaging confirmed a long-segment stricture in the upper left ureter accompanied by significant hydronephrosis and impaired renal function.

INTERVENTIONS

The patient underwent laparoscopic resection of the strictured segment followed by ureteroplasty using an autologous lingual mucosal graft. A double-J stent was placed, and the graft was secured with absorbable sutures and wrapped with omentum.

OUTCOMES

Postoperatively, the patient experienced 2 episodes of renal hemorrhage, likely exacerbated by anticoagulation during dialysis and underlying vascular fragility. After multidisciplinary management, including cessation of heparinized dialysis and transition to non-anticoagulant therapies, the bleeding resolved. Three-month follow-up showed patent ureter, resolved hydronephrosis, stable renal function, and no recurrence of symptoms.

LESSONS

Lingual mucosal graft ureteroplasty is a viable option for complex ureteral strictures, but careful patient selection is critical - particularly in those with chronic renal failure on dialysis. Intraoperative techniques to avoid renal pelvic injury and judicious postoperative anticoagulation management are essential to prevent hemorrhage. A multidisciplinary approach and close follow-up are key to successful outcomes.