Replacement of the ureter by small intestine: clinical application and results of the ileal ureter in 89 patients.

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95 per cent of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81 per cent of the cases. Serum creatinine was unchanged or decreased in 75.7 per cent and the pyelogram was unchanged or showed decreased dilatation in 84.6 per cent of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5 per cent) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.