Laparoscopic robot-assisted buccal mucosal graft (BMG) distal ureteroplasty is an advanced surgical technique for the treatment of distal ureteral strictures and complex ureteral reconstruction. When combined with autologous fascial sacrocolpopexy (AFS), this approach addresses both ureteral obstruction and pelvic organ prolapse in female patients, providing a minimally invasive, reconstructive solution. The incorporation of robotic assistance allows for enhanced precision and dexterity, making it a promising alternative to open or simple laparoscopic surgery.

This is the case of a 65 year-old female to whom a robot-assisted BMG distal ureteroplasty with AFS at a tertiary care center was performed. She had a symptomatic distal ureteral stricture (secondary to a mesh extrusion into the pelvic ureter) and concomitant pelvic organ prolapse relapse. Buccal mucosal graft was harvested and robotically transplanted to reconstruct the affected distal ureter, while autologous rectus-muscle fascia was used for sacrocolpopexy. Intraoperative time, perioperative complications, and postoperative outcomes were analyzed.

Operative time was 210 minutes, and mean estimated blood loss was 150 mL. There were no perioperative complications. Urethral catheter was removed postoperative day 5.  Double J stent was removed postoperative day 28. At 12 months, no recurrence of ureteral stricture was observed.

Laparoscopic Robot-assisted BMG distal ureteroplasty combined with AFS is a feasible and effective option for managing complex distal ureteral strictures alongside pelvic organ prolapse relapse in female patients. Robotic assistance allows for enhanced precision, minimizes surgical morbidity, and providing good functional outcomes. The use of autologous tissues for both ureteral and prolapse repair reduces the need for synthetic grafts and associated complications. Larger studies with longer follow-up periods are necessary to further validate these findings and refine surgical techniques.