We report the first successful use of a buccal mucosa graft for pyelo-ureteral fistula repair in a renal transplant recipient under immunosuppressive therapy.

A 73-year-old male developed a urinary fistula following kidney transplantation. Surgical revision revealed a 2-cm anterior wall defect, which was repaired using an onlay buccal mucosa graft and omental flap. Postoperative outcomes were favorable, with no leakage, stable renal function, and preserved graft perfusion.

This case highlights the feasibility and effectiveness of buccal mucosa grafting as a minimally morbid alternative to conventional techniques in complex ureteral reconstruction, even in immunosuppressed patients.

Buccal mucosa graft

Ureteral reconstruction

Kidney transplantation

© 2025 The Authors. Published by Elsevier Inc.