631 Nontransecting Anastomotic Augmentation Ureteroplasty – Joshi Step

Dr. Sanjay Kulkarni

Ureteric strictures are a recognized complication after ureteroscopy, with incidence ranging from 0.5–5% and even higher following laser lithotripsy. These strictures often become more challenging to manage after multiple endourological procedures, and recurrence remains a concern, particularly when a near-obliterative segment is not adequately addressed. Conventional buccal mucosa graft ureteroplasty has shown good results, but it may not be sufficient in such cases. To overcome this limitation, we adapted a principle from urethral stricture surgery—the Joshi step. This technique bridges mucosal gaps with mucosa-to-mucosa sutures at the narrowest point, thereby widening the ureteral plate while preserving its vascularity. Between January 2023 and January 2025, eleven robotic buccal mucosa graft ureteroplasties were performed, with the Joshi step applied in six cases. Outcomes were excellent, with no major complications and stable renal function in all patients. This simple modification offers a novel solution for near-obliterative ureteric strictures.
Procedure Innovation, Urologic Surgery, Ureteric Strictures

See more at: https://vattikutifoundation.com/videos/