The use of bowel interposed between proximal and distal ureter in urinary tract reconstruction

The replacement of lost ureter with bowel interposition is a feasible alternative in the reconstruction of the urinary tract. When adequate ureteral length is not present, interposition of a portion of small bowel between the proximal and distal ureteral segments is an option that minimizes the amount of bowel in the urinary tract. This, in turn, reduces mucus production and electrolyte absorption in the reconstructed urinary tract, and allows for more bowel to remain as part of the functioning gastrointestinal tract. This procedure allows use of the antirefluxing function of the normal ureterovesical junction when present. We have used successfully interposition of the small bowel between the proximal and distal ureteral segments for undiversion in 5 children. Generally, we strive to join urothelium to urothelium without the use of bowel in urinary tract reconstruction but when this is not feasible, bowel interposition has been a useful option.