Ileal Ureteral Substitution for Long Ureteric Structure/Segment Loss by Yang-Monti Technique. A Single Centre Experience

Abstract

A new technique for replacing the ureter based on the Yang-Monti principle is introduced to overcome the drawbacks of the classic ileal ureter. Between January 2007 and January 2014, ureteral replacement by ileum was indicated in nine patients, long or multiple strictures due to tuberculosis (6), retroperitoneal tumor (1) and iatriagenic ureteric injury during ureteroscopic (2). Exclusion criteria included patients with inflammatory bowel syndrome or irradiated bowel or a non-functioning renal unit. The technique involved isolation of a 9 cm ileal segment, which was further subdivided into three equal parts. Isolation of 9–10 cm of the terminal ileum (20 cm away from ileo-cacel valve) on their vascular bed was performed according to the length required to compensate the ureteral defect and according to the Yang-Monti principle, the isolated ileal segment was further subdivided into three equal parts (each 3 cm in length) with preservation of the individual blood supply. The continuity of the ileum was reestablished. Proximal and distal ileal segments were incised at their longitudinal axis close to the mesenteric border, were as center one along the anti-mesentric border. Unfolding of the incised segments with suturing of their adjacent ends resulted in the formation of an intestinal plate 2.5 cm wide and 18–24 cm long. This plate was tubularized around 16F Nelaton catheter using 4/0 absorbable sutures. The proximal end of the ileal tube was anastomosed to the ureter or renal pelvis while the distal end was anastomosed to the bladder using a non-refluxing Lich-Gregoir technique. At the end of the procedure, a ureteric silicon stent and a urethral catheter were left for 3 weeks and 10 days respectively. Postoperative follow-up showed no intestinal complications or significant morbidity. Early postoperative complications were minor in the form of prolonged urinary leakage, superficial wound infection and uncomplicated UTI that were managed properly without late harmful sequelae. No metabolic abnormalities occurred in any patient during early postoperative period. During follow up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function without any evidence of urinary obstruction. The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction.

Keywords: ileal segment, technique, Yang-Monti principle

Cite this Article

Nazir Syed Sajjad, Khan Muneer, Thakur Sajjad et al. Ileal ureteral substitution for long ureteric stricture/segment loss by Yang-Monti technique. A single center experience. Research and Reviews: Journal of Medicine. 2015; 5(3): 6–11p.