Application of Yang-Monti Principle in Ileal Ureter Substitution: Is It a beneficial Modification?

Esmat, Mohamed; Abdelaal, Amr; Mostafa, Diaa Eldin

doi:10.1590/1677-553820133806779

Cited by 21 publications

(28 citation statements)

References 15 publications

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“…However, postoperative urine leakage and localized urinary infection or peritonitis were observed in various studies in varying percentages. 27,28 Thus, temporary urinary diversion and using effective antibiotics prophylactically should be taken into account postoperatively. 27 Recently, Liu et al first confirmed the feasibility and safety of laparoscopic Yang-Monti ileal ureteral replacement in children with failed pyeloplasty for ureteropelvic junction obstruction.…”

Section: Yang-monti Ileal Uretermentioning

confidence: 99%

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

Xiong

Zhu

et al. 2020

Int J of Urology

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Long ureteral defects have remained a challenge to urologists for a long time. Bowel interposition, including ileal ureter, appendiceal interposition and reconfigured colon substitution, has gained wide acceptance, even though it is a complicated procedure and associated with some potential complications. Mucus obstruction and metabolic disorders are common complications of intestinal substitution. To circumvent these troubles, modified techniques, such as tapering the bowel graft, intestinal onlay flap and the Yang-Monti procedure, are used. In particular, Yang-Monti ileal ureter replacement is a highly effective option for ureteral reconstruction, and the incidence of complications would be significantly reduced in select patients. After being combined with the Boari flap or psoas hitch technique, the length of intestinal segment used can also be significantly reduced. Most recent long-term results suggest that ileal ureter replacement with antireflux anastomosis seems to be remarkably free of complications, and we highly praise the distal nipple valve technique. Appendiceal interposition is available for patients with normal appendix, and usually this procedure is limited to reconstructing the right ureter. Appendiceal onlay ureteroplasty has emerged as a feasible and effective option to manage patients with complex proximal and midureteral strictures of the right side. The colon is rarely used for ureteral reconstruction because of its large caliber and mucous surface area. However, a reconfigured colon segment is a good substitute to reconstruct long-segment ureteral defects, and longterm follow up confirmed minimal complications and improved renal function. This review provides a comprehensive perspective on complex ureteral reconstruction and replacement using intestinal segments, in particular, ileal ureter replacement.

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Section: Yang-monti Ileal Uretermentioning

confidence: 99%

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

Xiong

Zhu

et al. 2020

Int J of Urology

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“…The Yang-Monti technique for ileal ureteral reconstruction is used in clinical practice and has good curative effects [6][7][8] . The characteristics of this method are that the alternative ureteral tube diameter is the same as that of the original ureter, the intestinal tube is short, the diameter of the replacement tube is small, and the intestinal tube is saved.…”

Section: Introductionmentioning

confidence: 99%

“…However, there may be a backflow of urine from the bladder to the replacement ureter or ipsilateral kidney, resulting in postoperative intestinal dilatation, ascending infection, pyelonephritis, hydronephrosis, and impaired renal function [13] . To reduce the incidence of such complications, antireflux anastomosis involves the insertion of a nipple structure at the ileal bladder junction [14] , a proximal ileal wall tunnel anti-reflux procedure [15,16] , and an extra-urinary ureter tunnel extension (Lich-Gregoir method) [7,12] .…”

Section: Introductionmentioning

confidence: 99%

“…This is achieved via Yang-Monti ileal ureter and bladder anastomosis or Yang-Monti ileal ureter and lower ureteral anastomosis. [7] We established animal models of the Yang-Monti ileal ureter and bladder anastomosis and the Yang-Monti ileal ureter and lower ureteral anastomosis to evaluate which method is more convenient to perform, and to compare the advantages and disadvantages of both methods.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Yang-Monti ileal ureter-bladder anastomosis versus Yang-Monti ileal ureter-ureteral anastomosis for the treatment of ureteral stenosis: a randomized controlled trial in a miniature pig model

wang

Sun

Yang

et al. 2019

Preprint

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Background: The aim of the present study was to establish an animal model of Yang-Monti ileal ureter-bladder anastomosis and Yang-Monti ileal ureter-ureteral anastomosis and compare the advantages and disadvantages of the two surgical methods.Methods: Fourteen 12-month-old male Chinese miniature pigs weighing 21 ± 1.38 kg were randomly divided into two groups. Group A (n = 7) underwent end-to-end anastomosis of the left Yang-Monti ileal ureter, left ileal ureter and left lower ureter; group B (n = 7) underwent anastomosis of the left Yang-Monti ileal ureter, left ileal ureter and bladder. In both groups, the contralateral kidney was removed at 1 week postoperatively. The incision length and operation time of the two groups were compared. Changes in serum creatinine and urea nitrogen were observed preoperatively, and at 2, 6 and 12 weeks postoperatively. Venous pyelography and cystography were performed at 12 weeks postoperatively to determine the ureteral patency and vesicoureteral reflux. At 12 months postoperatively, urinary culture was performed, and the diameter and histological changes of the intestinal ureter were assessed.Results: Surgery was successfully completed in all 14 pigs. In group A, one pig died due to an anesthetic accident, and one pig died from a lung infection on postoperative day 4. In group B, one pig died from adhesive intestinal obstruction on postoperative day 7. The overall survival rate was 78.6%, and the 11 surviving pigs had no urinary or intestinal fistulae. Compared with group B, group A had a significantly longer surgical incision (30.86 ± 2.41 cm versus 26.71 ± 3.64 cm; p = 0.01) and shorter operation time (181.29 ± 15.10 min versus 157.71 ± 20.49 min; p = 0.02). The serum creatinine and urea nitrogen concentrations did not significantly differ between groups . All pigs had normal renal function pre- and postoperatively. There was no stenosis or obstruction on venous pyelography. The narrowest diameter of the ureter was significantly smaller in group B (5.90 ± 0.30 mm) than in group A (7.26 ± 1.06 mm; p = 0.01), but no contrast agent returned to the upper urinary tract in either group. Escherichia coli was detected on urine culture. In group A, one pig had obstruction of the ureteral ureter, while another had stenosis of the lower ureteral anastomosis. In group B, one pig had pelvic and intestinal ureteral dilatation; however, all anastomoses were patent. The ileal ureteral diameter was significantly larger in group A (9.40 ± 2.35 mm) than group B (6.62 ± 0.37 mm; p = 0.02). Two pigs in group A had separation of the transitional epithelium and columnar epithelial mucosa, with granulation tissue hyperplasia. The pigs with stenosis and obstruction had smooth fibrous tissue and smooth muscle of the anastomosis. In both groups, the two types of epithelial tissue were close together, and the intestinal villi were mildly atrophied and shortened.Conclusions: An animal model of Yang-Monti ileal ureter-bladder anastomosis was successfully established. Compared with Yang-Monti ileal ureter-ureteral anastomosis, Yang-Monti ileal ureter-bladder anastomosis is simpler, more reliable, and results in fewer complications.

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“…По мнению ряда авторов, формирование анастомоза может осуществляться без антирефлюксной защиты, а перистальтические волны подвздошного сегмента способны предотвра-тить обратный заброс мочи [23, 25,26]. Согласно дан-ным других авторов кишечная пластика мочеточника с антирефлюксным механизмом более предпочтитель-на [27][28][29].…”

Section: Introductionunclassified

Surgical treatment of the stricture of the lower third of ureter after radiation therapy of pelvic organs

Поляков¹,

Кешишев²,

Качмазов³

et al. 2016

Cancer Urology

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Application of Yang-Monti Principle in Ileal Ureter Substitution: Is It a beneficial Modification?

Cited by 21 publications

References 15 publications

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

Intestinal interposition for complex ureteral reconstruction: A comprehensive review

Comparison of Yang-Monti ileal ureter-bladder anastomosis versus Yang-Monti ileal ureter-ureteral anastomosis for the treatment of ureteral stenosis: a randomized controlled trial in a miniature pig model

Surgical treatment of the stricture of the lower third of ureter after radiation therapy of pelvic organs

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