Purpose-We reviewed indications and outcomes in patients undergoing ileal ureter replacement for ureteral reconstruction. December 1989 and September 2007, 105 patients underwent ileal ureter replacement, of whom 14 were excluded from study due to incomplete data. The remaining 91 patients (99 renal units) comprised the study cohort. Materials and Methods-BetweenResults-Mean patient age was 46.8 years and mean followup was 36.0 months. Indications for an ileal ureter were stricture following genitourinary surgery in 29 cases (31.9%), radiation induced stricture in 17 (18.7%), nonurological surgery iatrogenic injury in 16 (17.6%) and retroperitoneal fibrosis in 11 (12.1%). Only 4 patients (4.4%) had primary ureteral cancer. Long-term complications included anastomotic stricture in 3 patients (3.3%) and fistula in 6 (6.6%). Serum creatinine decreased or remained stable in 68 patients (74.7%) and hyperchloremic metabolic acidosis developed in 3. No patient complained of excessive urinary mucous production.Conclusions-In 68.1% of patients indications for an ileal ureter included radiation induced stricture or iatrogenic injury. The ileal ureter is a reasonable option for long-term ureteral reconstruction with preserved renal function in carefully selected patients. Keywordsureter; ileum; reconstructive surgical procedures; iatrogenic disease SINCE its first description in 1906 by Shoemaker 1 and later popularization by Goodwin et al in the late 1950s, 2 the use of ileal segments for ureteral substitution has become a valuable procedure in reconstructive urology. Although it was initially described for tubercular obstruction, recent decades have seen the indications for its use broaden. We report a contemporary series representing changes in indications, patient selection and clinical outcomes. PATIENTS AND METHODS Study DesignAfter receiving institutional review board approval we retrospectively analyzed the records of all patients who underwent ileal ureter replacement at

Renal function preservation and complications were similar for robotic, laparoscopic, and open partial nephrectomy.

Omission of cortical renorrhaphy appears feasible with no urine leaks or bleeding complications observed. The percent renal volume loss was improved by omission of cortical renorrhaphy. Reconstruction technique is important to control for when studying renal function after partial nephrectomy.

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