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Bridging long ureteral defects using the Yang-Monti principle
Bedeir Ali-el-Dein1, Mohamed A Ghoneim
1Department of Urology, Urology and Nephrology Center, Mansoura University, Egypt.
The Journal of Urology
|February 11, 2003
Summary
A novel Yang-Monti principle technique for ureteral replacement using ileum offers advantages over traditional methods. This method avoids metabolic complications and allows for a tailored, non-refluxing ileal ureter construction.
Area of Science:
- Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- The classic ileal ureter technique for ureteral replacement presents several drawbacks.
- Ureteral strictures, particularly those caused by bilharziasis and tuberculosis, necessitate effective reconstructive solutions.
Purpose of the Study:
- To introduce and evaluate a new ureteral replacement technique based on the Yang-Monti principle.
- To overcome the limitations associated with conventional ileal ureter substitution.
Main Methods:
- A 5 to 7.5 cm ileal segment was isolated and divided.
- The segment was unfolded into a strip (12-18 cm) and tubularized to create an ileal tube.
- The reconstructed ileal tube was implanted into the bladder using a non-refluxing ileovesicostomy.
Main Results:
- Mean follow-up was 9.6 months with stable serum creatinine in all 10 patients.
- Split kidney function remained stable or improved in all cases.
- Urography confirmed nonobstructed flow and excellent configuration of the ileal substitute, with minimal reflux.
Conclusions:
- The Yang-Monti principle technique allows for ureteral replacement with a short bowel segment, minimizing metabolic complications.
- This method enables the creation of an ileal ureter with an appropriate caliber without extensive tailoring.
- The technique facilitates the incorporation of an antireflux mechanism, improving outcomes.