Whole Ureter Reconstruction Using Yang-Monti ileal ureter reconstruction: successful treatment of challenging conditions
Chyau-Wen Lin１, Tzu-Pin Lin１２３, William J. Huang１２３
1Department of Urology, Taipei Veterans General Hospital;
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan;
3Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan
使用Yang-Monti手術進行全輸尿管重建
林巧文１ 林子平１２３ 黃志賢１２３
1臺北榮民總醫院 泌尿部; 2國立陽明大學醫學院泌尿學科;3書田泌尿科學研究中心
Introduction
Ureter injuries are one of most challenging issue in urology. For long-segment or total ureter discontinuation, there was no clear consensus of reconstruction.
We presented our experience of using Yang-Monti technique in total ureter reconstruction.
Materials and Methods
This study was a single-center and retrospective study. We included all patients who underwent Yang-Monti ileal whole ureter (from UPJ to UVJ) reconstruction in Taipei Veterans General Hospital in recent ten years.
The following data was collected: baseline patients’ characteristics, stricture etiology, and the time interval between insult and surgical repair, pre/post-operation serum creatinine, eGFR and split renal function, complication during admission and follow-ups, and the indwelling durations of JJ tube and nephrostomy tubes if presented.
Results
Totally 7 patients underwent Yang-Monti ileal ureter reconstruction from 2010-2019 in our hospital. Four of whom were women, the other three were men. One patient received bilateral ureter repair in one session. The etiology of ureter injury was recorded and radiation therapy-related fibrosis and degloving injury were the most common causes.
The median time interval between ureter insult and operation was 8 months. The median follow-up duration was 24 months while three patients were still on follow-ups. The average operation time was 11 hours, and the average blood loss was 259 ml.
There was no significant difference in either serum Creatinine, eGFR, or split renal function post-operatively. As for postoperative complications, there were four patients experiencing complications.
Patient number one had delayed patency of reconstructed ureter successfully treated with prolonged JJ stenting and there was no subsequent infection reported. Patient number 2 developed pelvic-neoureteral junction stenosis, and treated re-anastomosis surgery in three months. Patient 3 had urinary tract infection which needed admission once. Patient 5 had persistent asymptomatic hydronephrosis.
None of the patient reported metabolic acidosis, ileus, or electrolyte imbalance.
Conclusion
To our knowledge, this is the largest series of total ureter reconstruction by using Yang-Monti technique. There was no statistically pre-operative and post-operative difference noted at serum creatinine and split renal function. Of these seven patients, two of them experienced Clavien-Dindo grade III complications, which were able to manage with surgical intervention and left no long-term morbidities. Our study showed that Yang-Monti procedure was a feasible and effective approach for total ureter reconstruction.