• Logo
  • SBMUJournals

Improved Long Ureteral Reconstruction With Ileum By Longitudinal Clipping And Mucosal Stripping: An Animal Study

Hao Gu, Shulian Chen, Yubo Wu, Lei Shen, Yihang Luo, Xu Li, Houjin Huang, Zeju Zhao



Purpose: To investigate the possibility of bridging long ureteral defects by longitudinal clipping and mucosal stripping of the pedicled segment of ileum (CMSPI).

Materials and Methods: Ten beagle dogs (five males and females aged 2-3 years) were used to model a defect of the entire ureter. An ileal segment was selected, and half of the intestinal segment was longitudinally resected, without mesenteric resection. The intestinal mucosa was removed. Then, the ileum was sutured to form a tube connecting the renal pelvis to the bladder. A 5F ureter stent was inserted into the ileum and removed 4 weeks after surgery. Intravenous urography (IVU) was used to observe the reconstructed ureters at 6 and 12 weeks after the operation. Blood samples were collected before surgery and during each radiological examination to assess electrolyte and renal function. Five dogs were randomly euthanized after each IVU. After macroscopic analysis, hematoxylin-eosin (H&E) staining was performed to observe the microscopic changes in the reconstructed ureter.

Results: All dogs were in good condition after surgery. Changes in blood electrolyte and renal function after surgery were not significant (Cl- P = .595; Ur P = .852). IVU demonstrated no ureteral obstruction or extravasation of the contrast agent; however, mild hydronephrosis were observed in three dogs. Macroscopic analysis indicated that the reconstructed ureter was intact without strictures. H&E showed that no mucosal structure was present on the luminal surface.

Conclusion: CMSPI is feasible for bridging long ureteral defects and has shown good efficacy in this preliminary study.


Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol, 2014, 6(3):115-124.

doi: 10.1177/1756287214526767

Li Y, Li C, Yang S, Song C, Liao W, Xiong Y. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles.Urology, 2014, 83(5):1199-1204.

doi: 10.1016/j.urology.2014.01.027.

Engel O, Rink M, Fisch M. Management of iatrogenic ureteral injury and techniques for ureteral reconstruction. Curr Opin Urol, 2015, 25(4):331-335.

doi: 10.1097/MOU.0000000000000175

Shekarriz B, Lu H, Duh Q, Freise CE, Stoller ML. Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries. Urology, 2001, 58(4), 540-543.

doi: 10.1016/s0090-4295(01)01316-4

Goodwin WE, Winter CC, Turner RD. Replacement of the ureter by small intestine: clinical application and results of the ileal ureter. J Urol, 1959, 81:406-418.

doi: 10.1016/j.atmosenv.2015.11.052

Kim A, Nam W, Song SH, Jeong IG, Hong B. Use of the Ileum for Ureteral Stricture and Obstruction in Bilateral, Unilateral, and Single-kidney Cases. Urology, 2018, 111:203-207.

doi: 10.1016/j.urology.2017.08.008

Kocot A, Kalogirou C, Vergho D, Riedmiller H. Long-term results of ileal ureteric replacement: a-25-year single-center experience.BJU Int, 2017, 120: 273–279.

doi: 10.1111/bju.13825

Zhong W, Hong P, Ding G, et al. Technical considerations and outcomes for ileal ureter replacement: a retrospective study in China. BMC Surgery, 2019, 19(1):9.

doi: 10.1186/s12893-019-0472-1

Gild P, Kluth LA, Vetterlein MW, Engel O, Chun FKH, Fisch M. Adult iatrogenic ureteral injury and stricture–incidence and treatment strategies. Asian J Urol, 2018, 5(2): 101–106.

doi: 10.1016/j.ajur.2018.02.003

Ordorica R, Wiegand LR, Webster JC, Lockhart JL. Ureteral replacement and onlay repair with reconfigured intestinal segments. J Urol, 2014, 191:1301–1306.

doi: 10.1016/j.juro.2013.11.027.

Png JC, Chapple CR. Principles of ureteric reconstruction. Curr Opin Urol, 2000, 10(3):207-212.

doi: 10.1097/00042307-200005000-00004

Takeuchi M, Masumori N, Tsukamoto T. Ureteral reconstruction with bowel segments: experience with eight patients in a single institute. Korean J Urol, 2014, 55(11):742-749.

doi: 10.4111/kju.2014.55.11.742

Yang WH. Yang needle tunneling technique in creating antireflux and continent mechanisms. J Urol, 1993, 150(3):830-834.

doi: 10.1016/s0022-5347(17)35625-2

Monti PR1, Lara RC, Dutra MA. New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology, 1997, 49(1):112-115.

doi: 10.1016/S0090-4295(96)00503-1

Esmat M, Abdelaal A, Mostafa D. Application of Yang-Monti principle in ileal ureter substitution: is it a beneficial modification? Int Braz J Urol, 2012, 38(6):779-785.

doi: 10.1016/j.juro.2013.06.045

Bao JS, He Q, Li Y, Shi W, Wu G, Yue Z. Yang-Monti principle in bridging long ureteral defects: cases report and a systemic review. Urol J, 2017, 14:4055–4061.

doi: 10.22037/uj.v14i4.3928

Narayanaswamy B, Wilcox DT, Cuckow PM, et al. The Yang-Monti ileovesicostomy: a problematic channel?[J]. BJU Int, 2015, 87(9):861-865.

doi: 10.1046/j.1464-410x.2001.02208.x

Zou Q, Fu Q. Tissue engineering for urinary tract reconstruction and repair: Progress and prospect in China. Asian J Urol, 2018, 5(2):57–68.

doi: 10.1016/j.ajur.2017.06.010

Smith TG 3rd, Gettman M, Lindberg G, et al. Ureteral replacement using porcine small intestine submucosa in a porcine model. Urology, 2002, 60(5):931-934.

doi: 10.1016/S0090-4295(02)01890-3

El-Assmy A, Hafez AT, El-Sherbiny MT, et al. Use of single layer small intestinal submucosa for long segment ureteral replacement: a pilot study. J Urol, 2004, 171(5):1939–1942.

doi: 10.1097/01.ju.0000121437.94629.ef

Paul K. J. D. de Jonge, Vasileios Simaioforidis, Paul J. Geutjes, et al. Recent advances in ureteral tissue engineering. Curr Urol Rep, 2015, 16(1):465.

doi: 10.1007/s11934-014-0465-7

Elliott SP, McAninch JW. Ureteral injuries: external and iatrogenic. Urol Clin North Am, 2006, 33(1):55-66.

doi: 10.1016/j.ucl.2005.11.005

DOI: http://dx.doi.org/10.22037/uj.v0i0.5330


  • There are currently no refbacks.