The following is a summary of “Whole ureter replacement with Yang–Monti principle: successful treatment of challenging conditions” published in the December 2022 issue of Urology by Lin et al.
There isn’t a clear agreement on how to fix a long segment or total ureter discontinuation. Here, researchers discuss our experience with total ureter reconstruction using the Yang–Monti method. This was a look back at patients who had Yang–Monti ileal whole ureter reconstruction at a single center (from the ureteropelvic junction [UPJ] to the ureterovesical junction). Data were collected on the baseline characteristics of the patients, the cause of the stricture, the time between the injury and the surgery to fix it, the serum creatinine levels before and after surgery, the estimated glomerular filtration rate (eGFR), split renal function, complications during admission and follow-ups, and the length of time that JJ tubes and nephrostomy tubes stayed in place if they were used.
Between 2010 and 2020, 7 people at the hospital had Yang–Monti ileal ureter reconstruction. One of the patients had bilateral ureter repair done in a single session. Most ureter injuries were caused by fibrosis and degloving injuries caused by radiation therapy. The average amount of time between ureter damage and surgery was 8 months. The average time to follow up was 36.7 months. On average, the surgery took 11,4 hours, and 273 ml of blood was lost. After the surgery, there were no big changes in serum creatinine, eGFR, or split renal function. As for complications after surgery, 2 patients had ileus, which was treated by doing nothing.
One patient had UPJ stenosis, but went away 11 months after re-anastomosis surgery. There were no reports of metabolic acidosis or an electrolyte imbalance. Investigators found that using the Yang–Monti principle to replace a lost ureter with the ileum works and lasts. This is the largest study with more than 2 years of follow-up on a group of people.