Ileal ureter substitution: a contemporary series

To review our contemporary experience with ileal ureter reconstruction. Despite advancements in surgical technology and technical expertise, ureteral injuries continue to occur. These injuries can be extensive, and ileal ureter reconstruction may be necessary.

A total of 18 ileal ureter substitutions were performed in 16 adults (10 men and 6 women) by a single surgeon during a 6-year period. The mean patient age was 49.4 years (range 25 to 72). The mean follow-up was 18.6 months (range 7 to 59). All ileal ureter substitutions were performed in an isoperistaltic, refluxing fashion. Follow-up included clinical evaluation, nuclear renography, intravenous urography, and serum chemistry testing.

Postoperative nuclear renography demonstrated no relative loss of function of the affected renal unit and no evidence of functional obstruction. An unobstructed state was also confirmed with intravenous urography. No statistically significant metabolic changes were found in any patient, as assessed by serum chemistry testing. None of the patients had evidence of new stone formation. Two patients developed an isolated, symptomatic urinary tract infection during follow-up, and one has had recurrent urinary tract infections, a problem that was present preoperatively.

Ileal ureter substitution remains an effective treatment for patients with complex ureteral strictures or injuries. Stone activity does not appear to increase, and metabolic sequelae are uncommon in properly selected patients.