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Reconfigured Colon Ureteral Substitute

The reconfigured colon substitute applies the Yang-Monti principle of detubularization and transverse retubularization to a short colonic segment (~3 cm) to bridge long ureteral defects. The resulting tube has near-ureteral caliber and minimal mucosal surface, fitting a niche where the classic ileal ureter and the Yang-Monti ileal ureter are unsuitable — in selected patients with unavailable small bowel or a suitable nonirradiated colonic segment; reduced renal reserve remains a concern with either bowel segment.[1][2][3]

Lineage​

  • 1996 — Pope and Koch first reported a reconfigured ascending colon segment to replace a long ureteral defect.[3]
  • 2001 — Ubrig, Waldner, and Roth formalized transverse retubularized colon segments using a 3 cm ascending or descending colon harvest.[2]
  • 2003 — Ubrig and Roth reported 7 selected patients, including 3 solitary-kidney patients treated with a cutaneous conduit; this small series does not establish safety across degrees of renal impairment.[4]
  • 2012 — Lazica et al. reported 14 patients, with median follow-up 52.4 months for the renal-function assessment and 95.8 months among the 6 surviving patients.[1]

Why Colon Instead of Ileum​

Colon is rarely used in its native (non-reconfigured) form because of its wide caliber and large mucosal surface. Reconfiguration reduces caliber and mucosal surface. Selection depends on bowel health, vascular reach and renal reserve; comparative clinical superiority over ileum has not been established:[1][2][4]

  • Anatomic proximity — ascending colon lies adjacent to the right ureter, descending colon to the left, minimizing mesenteric mobilization.
  • Retroperitoneal access — flank or pararectal incision, with minimal intraperitoneal dissection.
  • Renal insufficiency — both ileal and colonic urine contact can impose an acid load. Do not select colon on an assumption of metabolic safety; assess renal reserve and alternatives carefully.[10]
  • After pelvic radiation — confirm that the proposed colon segment and its vascular supply are outside damaged tissue; prior radiation does not by itself favor colon.
  • When ileum is unavailable — prior extensive ileal resection or other loss of usable ileum; inflammatory bowel disease may also make colon unsuitable.
  • Caliber — after reconfiguration, the tube is ureter-sized and does not require tapering.
  • Access — a retroperitoneal approach may be possible in selected anatomy; lower morbidity than ileal substitution is unproven.

Surgical Technique​

The same fundamental principle as the Yang-Monti ileal ureter, with colon as the source segment:[1][2][3][4]

  1. Access. Flank or pararectal incision, predominantly retroperitoneal.
  2. Segment selection. A ~3 cm segment of ascending colon (right-sided defects) or descending colon (left-sided), chosen immediately proximal to the ureteral defect to limit mesenteric mobilization.
  3. Bowel continuity. Restore continuity of the remaining colon with a well-perfused, tension-free bowel anastomosis.
  4. Detubularization. Open the segment along the antimesenteric border.
  5. Reconfiguration. Lay the opened segment flat into a rectangular mucosal strip.
  6. Retubularization. Tubularize transversely over a stent, converting the short wide segment into a longer narrow tube. A 3 cm colonic segment yields ~6–8 cm of tube.
  7. Anastomosis. Spatulated proximal end-to-end anastomosis to renal pelvis or proximal ureteral stump; distal anastomosis to the distal ureteral stump, bladder (with or without submucosal tunnel), or afferent limb of an ileal neobladder.[1]
  8. Stenting. Internal ureteral stent for several weeks postoperatively.

Variations​

  • Pyelo-colo-cutaneostomy. Two combined reconfigured colon segments anastomosed to skin function as a modified colon conduit when bladder reimplantation is not feasible.[2][4]
  • Double Monti sigmoid. Sigmoid-colon double-Monti tube combined with a Boari flap has been reported for total left ureteral substitution with stable split function at 3.25 yr.[6]

Indications​

When simpler options are insufficient and ileum is unsuitable, particularly:[1][2][3][4]

  • No satisfactory native-tissue or graft repair, with sufficient renal reserve to tolerate bowel interposition.
  • Prior pelvic irradiation sparing the colon.
  • Unavailable ileum, provided the selected colon is healthy and well vascularized.
  • Solitary kidney only after careful assessment of function and alternatives; the small published experience is not proof of metabolic protection.
  • Upper and mid ureteral defects where the colon lies adjacent.
  • Need for cutaneous diversion as a pyelo-colo-cutaneostomy.

Common etiologies: iatrogenic injury, malignancy, retroperitoneal fibrosis, radiation strictures.[1][7]

Long-Term Outcomes​

Lazica 2012 — 14 patients; longer follow-up available in 6 survivors[1]​

ParameterResult
Good renal function10/14 at median 52.4 months
Stent-free at longer follow-up6 surviving patients at median 95.8 months
Obstruction of ureteral replacementNone
Metabolic disordersNone
Mucus obstructionNone
Stricture or adhesive ileusNone
Reinterventions7 patients required 11 reinterventions
Procedure-related deathsNone

Ubrig & Roth 2003 — n = 7 (3 solitary kidneys, mean 23 mo follow-up)[4]​

No segment-related complications were reported during the small series' follow-up. The 3 solitary-kidney patients received cutaneous conduits, so their results should not be presented as evidence specifically for interposition to the bladder.

Mixed intestinal substitution — Chung 2006, n = 56 (4 colonic, mean 6 yr)[7]​

Renal function preserved overall (median creatinine 1.0 mg/dL pre and post). Major complications occurred in 10.5% of this mixed cohort; its results do not isolate the 4 colonic substitutions.

Complications​

ComplicationRate (Lazica n = 14)Notes
MetabolicNoneNone observed in this small cohort; this does not establish absence of metabolic risk.[1][2]
Mucus obstructionNoneMinimal mucosal surface vs non-reconfigured bowel.[1]
Anastomotic strictureNone[1]
Urinary tract infection3/14 (21%)At 4 wk, 3 mo, 112 mo.[1]
Prolonged stenting required4/14 (29%)[1]
Secondary drainage3/14 (21%)[1]
Bowel obstruction1/14 (7%)From peritoneal carcinosis, not the reconstruction.[1]
Ureteral fistulaRareReported in irradiated patients in mixed reconfigured-intestinal series.[8]
Long-term malignancy of the bowel segmentUncertain for this techniqueLifelong follow-up is needed; a reliable technique-specific incidence is not established.[9]

Choosing the Bowel Segment​

The reconfigured colon and Yang-Monti ileal tube use less bowel length than a conventional ileal ureter, but add retubularization suture lines and depend on preserved mesenteric perfusion. Choose according to defect geometry, healthy bowel availability, prior operations and radiation, renal reserve, and surgeon experience. Small selected series with different follow-up cannot establish lower rates of acidosis, obstruction or reintervention for one segment.[1][2][5][6]

Bowel substitution requires surveillance for obstruction, infection, renal decline and metabolic complications. Current EAU trauma guidance cautions against ileal replacement in patients with impaired renal function; substituting colon does not remove the need to assess this risk.[10]

Onlay Variation​

Reconfigured colon (or ileum) can also be used as an onlay flap rather than a circumferential interposition: the strip is laid over a preserved but strictured ureteral plate (opened longitudinally) without complete resection, sparing native ureteral tissue and blood supply. Ordorica et al. reported mixed repairs in 13 patients and 16 ureters (13 ileal, 1 colonic and 2 appendiceal). The 14 remaining renal units drained after one patient required cystectomy for radiation-related fistula and another lost function in one renal unit. These are neither 100% success in all treated units nor colon-specific onlay outcomes.[8]

Special Populations​

  • Solitary kidney. All 3 solitary-kidney patients in the Ubrig & Roth series had no complications related to the colon segment.[4]
  • Cutaneous diversion needed. Pyelo-colo-cutaneostomy (two combined reconfigured colon segments to skin) functions as a modified colon conduit.[2][1]

See Also​

References​

1. Lazica DA, Ubrig B, Brandt AS, von Rundstedt FC, Roth S. Ureteral substitution with reconfigured colon: long-term followup. J Urol. 2012;187(2):542–548. doi:10.1016/j.juro.2011.09.156

2. Ubrig B, Waldner M, Roth S. Reconstruction of ureter with transverse retubularized colon segments. J Urol. 2001;166(3):973–976.

3. Pope J, Koch MO. Ureteral replacement with reconfigured colon substitute. J Urol. 1996;155(5):1693–1695.

4. Ubrig B, Roth S. Reconfigured colon segments as a ureteral substitute. World J Urol. 2003;21(3):119–122. doi:10.1007/s00345-003-0320-9

5. Xiong S, Zhu W, Li X, et al. Intestinal interposition for complex ureteral reconstruction: a comprehensive review. Int J Urol. 2020;27(5):377–386. doi:10.1111/iju.14222

6. Castellan M, Gosalbez R. Ureteral replacement using the Yang-Monti principle: long-term follow-up. Urology. 2006;67(3):476–479. doi:10.1016/j.urology.2005.09.005

7. Chung BI, Hamawy KJ, Zinman LN, Libertino JA. The use of bowel for ureteral replacement for complex ureteral reconstruction: long-term results. J Urol. 2006;175(1):179–183; discussion 183–184. doi:10.1016/S0022-5347(05)00061-3

8. Ordorica R, Wiegand LR, Webster JC, Lockhart JL. Ureteral replacement and onlay repair with reconfigured intestinal segments. J Urol. 2014;191(5):1301–1306. doi:10.1016/j.juro.2013.11.027

9. Martini A, Villari D, Nicita G. Long-term complications arising from bowel interposition in the urinary tract. Int J Surg. 2017;44:278–280. doi:10.1016/j.ijsu.2017.07.030

10. European Association of Urology. EAU Guidelines on Urological Trauma. Ureteral injury management and long-segment replacement. Current online guidance accessed September 12, 2026. Guideline.