Ureteral reconstruction using a tapered non-vascularized bladder graft: an experimental study in a canine animal model

BACKGROUND: Reconstruction of ureteral defects and strictures remains problematic for urologists. We aimed to investigate the possibility of a tapered non-vascularized bladder graft as a novel substitute for ureteral reconstruction. METHODS: This experimental study was conducted on nine beagles. Under general anesthesia, a full-thickness graft with 5–6 cm in length was disassociated from the anterior upper wall of the bladder, and tapered into 1/3 to 1/2 thickness, remaining the urothelial surface. After removal of 5 cm of right-sided mid-ureter, the tapered bladder graft was tubularized along the long axis and then respectively anastomosed to the upper and lower stumps of the ureter. A retrograde urography through a cystostomy was performed 8 weeks after the ureteral reconstruction. The animals were euthanized, and histopathologic examinations of the neoureters were performed. RESULTS: There were no severe complications during postoperative follow-up. The urography indicated patent urine excretion and no fistula or stenosis. Histopathologic examinations of the neoureters showed open lumen with urothelial lining. Nutrient vessels were observed in healthy submucosa, lamina muscularis and peripheral connective tissue. CONCLUSIONS: Our study implied that ureteral reconstruction by a tapered non-vascularized bladder graft was anatomically possible in our animal model. Further studies are expected to confirm long-term and functional outcomes.