Application of the “Yang-Monti principle” in children with iatrogenic ureteral injuries

Patil, Neehar; Javali, Tarun

doi:10.1016/j.jpurol.2021.04.022

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…However, there are some intrinsic drawbacks of ileal substitutes, such as large tract lumen, mucous secretion, and metabolite absorption, which usually lead to pertinent complications like uroschesis, metabolic acidosis, electrolyte imbalance, and mucus obstruction [ 5 ]. Several modified techniques are proposed, including tapering the bowel graft, intestinal Onlay flap, and the Yong-Monti procedure, but only part of the issues is solved [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Replacement of long-segment ureteral defect with tapered demucosalized ileum: medium-term outcomes of 4 patients

Chen

Tang

et al. 2023

BMC Urol

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Purpose Repair of long-segment ureteral defect (LSUD) is challenging. Currently available procedures carry some potential complications. We modified the ileal graft by tapering the wall and stripping the mucosa to combat associated pitfalls and first reported the medium-term outcomes of 4 patients. Material and methods From September 2019 to October 2020, tapered demucosalized ileum (TDI) was used for LSUD reconstruction in 4 patients on the right (2 males and 2 females). Two patients were with panureteral avulsion and 2 with high-risk urothelial carcinoma in the distal ureter. TDI was made by tapering 1/2–2/3 of the antimesenteric ileal wall and stripping the mucosa with a blunt/blunt operating scissor. Follow-up modalities included serum creatinine, electrolytes, ultrasonography, CT urogram, renal scintigraphy, and ureteroscopy. Results Mean operation time was 443 min (range 360–550) and blood loss was negligible. The mean follow-up period was 29 months (range 23–36). Vesicoureteral reflux and related pyelonephritis occurred in 1 patient, necessitating a repair operation (Clavien-Dindo grade IIIb). No strictures, obstructions, metabolic disorders, or electrolyte imbalances were observed in the remaining patients. In carcinoma patients, ureteroscopy in month 18 post-operation revealed ileal mucosal regrowth in the form of dwarf isolated islands. All renal units maintained adequate drainage and function during the follow-up. Conclusions Ileal wall tapering and mucosa stripping confined to the muscularis mucosae level will not result in shrinkage, fibrosis, or stricture formation of the ileal ureter. The present work provides evidence for further application of TDI in the replacement of LSUD in patients.

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Section: Introductionmentioning

confidence: 99%

Replacement of long-segment ureteral defect with tapered demucosalized ileum: medium-term outcomes of 4 patients

Chen

Tang

et al. 2023

BMC Urol

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“…Benign distal ureteral strictures (DUS) in pediatrics are usually caused by urolithiasis, iatrogenic injury, infection, or simply because of congenital developmental abnormalities [ 1 , 2 , 3 ]. Ureteral obstruction due to stricture formation can lead to significant morbidity, such as chronic pain, infection, hydronephrosis and eventual irreversible renal injury, while posing a challenging disease entity for urologists due to the wide spectrum of treatment modalities required [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center

Guo

Yang

et al. 2022

JCM

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Objective: Robot-assisted laparoscopic ureteral reimplantation (RALUR) and trans-umbilical multiport laparoscopic ureteral reimplantation (TMLUR) are both minimally invasive procedures for benign distal ureteral stricture (DUS). However, TMLUR has rarely been reported in published research, thus the difference in mid-term outcome of these two procedures warrants investigation. Methods: Patients who underwent RALUR or TMLUR for pediatric DUS from April 2017 to November 2020 at our institution were retrospectively analyzed and 56 patients were included in this retrospective comparison. Demographic characteristics, perioperative data and follow-up results were collected and analyzed in RALUR and TALUR groups. Results: RALUR and TMLUR were successfully performed in children aged from 12.0 to 142.0 months, without conversion to open ureteral reimplantation. RALUR took shorter operative time than TMLUR (p = 0.005) with less blood loss (p = 0.001). Meanwhile, patients receiving RALUR encountered a greater financial burden (p < 0.001) with less cosmetic satisfaction than TMLUR. The mean mid-term follow-up time for RALUR and TMLUR was 18.29 months and 24.64 months, respectively. Mid-term follow-up data showed that DUS was relieved with improved renal function after surgery in both groups, with no significant difference. Conclusions: RALUR and TMLUR are both safe and efficient for DUS treatment and achieve comparable mid-term outcomes in children. RALUR can reduce operative time and operative blood loss benefiting from its prominent technical superiority, but may currently bring about greater financial burden, with cosmetic satisfaction remaining to be improved.

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Managing Intraoperative Complications and Consequences

Pio

Lautz

2023

Pediatric Surgical Oncology

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Application of the “Yang-Monti principle” in children with iatrogenic ureteral injuries

Cited by 4 publications

References 18 publications

Replacement of long-segment ureteral defect with tapered demucosalized ileum: medium-term outcomes of 4 patients

Replacement of long-segment ureteral defect with tapered demucosalized ileum: medium-term outcomes of 4 patients

Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center

Managing Intraoperative Complications and Consequences

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