Whole ureter replacement with Yang–Monti principle: successful treatment of challenging conditions

Abstract

No clear consensus has been reached on the reconstruction of long-segment or total ureter discontinuation. Here we present our experience using the Yang-Monti technique in total ureter reconstruction. This study was a single-center retrospective study of patients who underwent Yang-Monti ileal whole ureter reconstruction (from the ureteropelvic junction[UPJ] to the ureterovesical junction). Data were collected on patients' baseline characteristics, stricture etiology, the time interval between insult and surgical repair, pre/postoperative serum creatinine, estimated glomerular filtration rate (eGFR), split renal function, complications during admission and follow-ups, and the indwelling durations of JJ tubes and nephrostomy tubes, if presented. Seven patients underwent Yang-Monti ileal ureter reconstruction in 2010-2020 at our hospital. One of the patients underwent single-session bilateral ureter repair. Radiation therapy-related fibrosis and degloving injury were the most common etiologies for ureter injury. The median interval between ureter insult and operation was 8months. The median follow-up was 36.7months. The average operation time was 11.4h, and the average blood loss was 273ml. Postoperatively, no significant differences were found in serum creatinine, eGFR, or split renal function. As for postoperative complications, two patients experienced ileus and were treated conservatively. One patient had UPJ stenosis, which resolved after re-anastomosis surgery 11months later. Metabolic acidosis or electrolyte imbalance was not reported. We found that ileal replacement of total ureteral loss using the Yang-Monti principle is effective and durable. This is the largest cohort study conducted with more than 2years of follow-up.