Ileal ureter replacement was first described by Shoemaker in 1906, and has proved to be a reliable procedure for urinary reconstruction (7). Replacement of the ureter with ileum is performed in certain clinical indications where a long segment or the entire length of the ureter needs to be replaced. The only other alternative in these cases is the more complicated renal autotransplantation (8,9).
Indications for ileal ureter replacement include long or multiple ureteric strictures (inflammatory, iatrogenic, radiation, retroperitoneal scarring), multifocal tumors, and repeated episodes of stone passage with pain and obstruction.
Ileal ureter replacement is most commonly performed unilaterally, however in cases with bilateral ureteric pathology, a bilateral replacement procedure can be performed with a single loop of small bowel reaching from both renal units to the bladder in an inverted L-fashion.
The shortest possible length of ileum should be used to minimize absorption of urinary components and kinking of the ileum. If the proximal ureter is healthy, it can be spared and anastomosed to the proximal part of the ileal loop.
Healthy distal ureter, however, cannot be used because the ileal peristalsis is not strong enough to pass the urine bolus into distal ureter, and a functional obstruction will result. In other words, the distal extent of the ileum has to be anastomosed to the urinary bladder.
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