Renal Autotransplantation After Yang-Monti Neoureter Procedure: Surgical Case Report and Brief Literature Review.

PURPOSE: Ureteral strictures are a well-documented pathology in urology, commonly resulting from congenital anomalies, iatrogenic injury, or other acquired conditions such as infection, trauma, or radiation. While ischemic and nonischemic strictures are recognized, bilateral idiopathic ureteral strictures remain rare, particularly when associated with systemic thrombotic microangiopathy. This case report describes a 25-year-old female with a history of IgA deficiency and atypical hemolytic uremic syndrome (aHUS), who developed bilateral ureteral strictures following envenomation by a brown recluse spider. The purpose of this report is to highlight an unusual cause of ureteral stricture formation, discuss its underlying pathophysiology, and evaluate long-term surgical outcomes, including the failure of a Yang-Monti neoureter and the subsequent necessity for left renal autotransplantation.

RESULTS: The patient initially developed bilateral ureteral ischemia and subsequent stricture formation, requiring percutaneous nephrostomy tubes for urinary drainage. The left ureter exhibited an 8-9 cm occlusion, leading to the decision to perform a Yang-Monti neoureter using a jejunal interposition graft. Despite initial surgical success, the patient later presented with left-sided hydronephrosis and recurrent urinary tract infections, revealing complete stricture of the neoureter. After thorough evaluation, she underwent left renal autotransplantation with ureteral reimplantation. Postoperative outcomes were favorable, with stable renal function, although complicated by transient ileus. This case underscores the challenges of managing extensive ureteral stricture disease, particularly when secondary to systemic microangiopathic processes triggered by envenomation.

CONCLUSIONS: To our knowledge, this is the first documented case of long-segment ureteral stricture as a sequela of brown recluse spider envenomation. The venom's prothrombotic and endothelial-damaging effects likely contributed to progressive ischemic injury and fibrosis, leading to bilateral stricture formation. While the Yang-Monti technique provided temporary urinary diversion, its long-term viability was limited, necessitating a definitive solution via renal autotransplantation. This case highlights the need for increased awareness of envenomation-related ischemic complications, particularly in patients presenting with delayed-onset ureteral obstruction. Future research should further explore envenomation-induced microangiopathy and optimal surgical management strategies for complex ureteral stricture disease.