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Updated: Oct 24, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Multi-institutional data analysis and literature review of comparative outcomes of autologous ureteral substitution
Brooke Hildebrand1,2, Neerja Tillu3, Maurizio Buscarini3
1School of Medicine, St. George's University, St. George's, Grenada.
Introduction:
Complex ureteral strictures often require substitution techniques to preserve renal function. Multiple autologous reconstruction options exist, yet comparative outcome data across techniques remain limited.
Material And Methods:
This multicenter retrospective cohort study included 168 patients who underwent ureteral reconstruction using ileal interposition, Yang-Monti tabularization, appendiceal interposition, or fallopian tube substitution. Preoperative, intraoperative, and postoperative variables were analyzed. Renal function outcomes were assessed using serum creatinine and estimated glomerular filtration rate (GFR). Complications were classified according to the Clavien-Dindo system.
Results:
Postoperative renal function improved significantly across the cohort, with mean creatinine decreasing from 2.19 ±1.35 mg/dl to 1.68 ±0.93 mg/dl (p <0.001) and mean GFR increasing from 58.3 ±17.4 ml/min to 65.6 ±15.0 ml/min (p <0.001). No statistically significant differences were observed among reconstruction techniques in renal outcomes, complication rates, or operative variables (p >0.05). Electrolyte disturbances (12%) and infections (11%) were the most common complications.
Conclusions:
Ileal, Yang-Monti, appendiceal, and fallopian tube ureteral substitutions demonstrate comparable outcomes in renal preservation and complication profiles. These findings support individualized surgical decision-making based on patient-specific factors rather than inherent superiority of a specific technique.