Ileal Ureter Replacement for Radiation-induced Long-segment Ureteral Stricture in a Patient with Prior...

Ileal ureter replacement is generally reserved for extensive ureteral defects not amenable to conventional reconstructive options. We report a challenging case of radiation-induced long-segment ureteral stricture in a 56-year-old woman with a history of carcinoma of the anal canal treated with abdominoperineal resection, sigmoid colostomy, chemotherapy, and radiotherapy. She subsequently developed bilateral ureteric obstruction with a small-capacity bladder. Right-sided stenting was feasible, but left-sided stenting failed, requiring percutaneous nephrostomy. She underwent an exploratory laparotomy with left ileal ureter replacement after endourological management of the right ureter. Intraoperatively, dense pelvic fibrosis, prior surgical scarring, bowel adhesions, intrarenal pelvis, and long-segment left ureteric obliteration made reconstruction technically demanding. Despite these challenges, the patient tolerated the procedure well, serum creatinine showed a declining postoperative trend, and recovery was uneventful. This case highlights the utility of ileal ureter replacement as a salvage option in selected patients with complex ureteral loss in hostile pelvic anatomy.