Yang-Monti ileal ureter reconstruction

摘要

Objective. The aim of this study was to present experience with ureteral reconstruction using the Yang-Monti technique with reconfigured ileal segments. Material and methods. Between 2006 and 2010, five patients underwent complete unilateral ureteral substitution with the Yang-Monti technique, whereby short segments of ileum were incised paramesenterically, joined and transversely tubularized to form a neoureter of suitable length and cross-sectional diameter to bridge large ureteral defects. The causes of the ureteral defects were strictly iatrogenic. Two of the five patients were reconstructed acutely, while the others were repaired after 3-5 months with a nephrostomy diversion in the intervening period. Results. Four of the five patients had patent neoureters, while one sustained a stricture, necessitating permanent double-J stenting. Mean follow-up was 41 months (range 13-62 months). Split renal function for two of the patients was markedly reduced but notably with no elevation in creatinine or apparent loss of renal function. Three of the five patients had immediate postoperative urinary leakage at the proximal anastomosis, necessitating drainage, prolonged double-J stenting and/or nephrostomy diversion. Conclusion. In cases of ureteral defects deemed too extensive for traditional reconstruction techniques such as the psoas hitch and/or Boari flap, the technique demonstrated here, using reconfigured ileal segments, is a viable alternative to nephrectomy and autotransplantation. Acute reconstruction within 24 h after the ureteral lesion is also feasible. In general, care must be taken to avoid urinary leakage, particularly at the proximal anastomosis, which may result in prolonged hospitalization and double-J stenting. The protocol should include frequent follow-up to avoid long-term loss of renal function.