A 38-year-old female presented with long stricture in the left upper ureter following a pyeloplasty causing persistent flank pain. A left PCNL with an antegrade endopyelotomy was attempted in view of a concomitant left renal 1.5 cm calculus in the lower calyx but it failed. Subsequently, a buccal mucosal onlay graft was applied on the strictured ureter. Follow-up at 3 months showed good uptake of the graft with patent passage for urine drainage.