title: Application of Yang-Monti principle in ileal ureter substitution: is it a beneficial modification?
abstract: OBJECTIVE
  Ureteric substitution using the Yang-Monti principle was reported as a modification of simple ileal ureter replacement. In this study, we evaluate its safety, surgical outcome and impact on renal function.
  
  
  METHODS
  Sixteen patients underwent ileal ureter replacement using the Yang-Monti principle to overcome long ureteric defects. Exclusion criteria included patients with elevated serum creatinine > 1.8 mg/dL, inflammatory bowel syndrome or irradiated bowel. Antireflux implantation into the bladder was performed in 12 patients while 4 patients with intact healthy lower ureters underwent distal ileal-ureteral anastomosis. Follow-up protocol was carried out for up to 3 years in 9 patients.
  
  
  RESULTS
  No intra-operative or postoperative mortality or significant complications occurred. There were minor complications in the form of urinary leakage that necessitated prolonged ureteric stenting in one patient, superficial wound infection in another one and 3 patients developed treatable urinary tract infection without late harmful effects. During follow-up, no excess mucus production or metabolic abnormalities were encountered. All patients had preserved renal function (improved in 13 patients and stabilized in 3) without any evidence of urinary obstruction.
  
  
  CONCLUSIONS
  The reconfigured ileal segment for ureteric substitution is a safe technique with an excellent outcome. It uses short ileal segments for reconstruction of an ileal tube of adequate length and optimal caliber that permits easy antireflux implantation into the bladder so it is not associated with excess mucus production or metabolic abnormalities and offers a durable preservation of renal function without urinary obstruction.
authors.affiliation: Department of Urology, Ain Shams University, Cairo, Egypt. m_esmat_2000@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Esmat
authors.forename: A
authors.initials: A
authors.lastname: Abdelaal
authors.forename: D
authors.initials: D
authors.lastname: Mostafa
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015203:Reproducibility of Results; D019738:Surgically-Created Structures; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D055815:Young Adult