Editing Management of Upper Urinary Tract Obstruction (section)

===== Ileal ureter substitution =====
* '''Reconstruction of the ureter with urothelium-based tissue is most preferable because it is not absorptive and is resistant to the inflammatory and potentially carcinogenic effects of urine. Incorporation of other tissue is reserved for situations in which a defect cannot be bridged by other methods.'''
* Delayed ureteral repairs, especially when a very long segment of ureter is destroyed, can be performed by creation of a '''ureteral conduit out of ileum''' in much the same way that an ileal conduit is constructed to drain the urine after cystectomy.; appendix and fallopian tube have been found to be unreliable ureteral substitutes.
* '''When an isoperistaltic segment of ileum is directly anastomosed to the bladder, reflux and renal pelvic pressure increase are usually seen only during voiding.''' The retrograde transmission of intravesical pressure is dependent on the length of ileum segment used in interposition and the voiding pressure
* '''Only 12% of patients with normal preoperative renal function developed significant metabolic problems postoperatively, and preoperative renal function was identified to be an important prognostic factor'''
* '''<span style="color:#ff0000">Not recommended in the acute setting</span>'''
* '''<span style="color:#ff0000">Contraindications (4):</span>'''
*# '''<span style="color:#ff0000">Baseline renal insufficiency</span> (creatinine > 2 mg/dL)'''
*# '''<span style="color:#ff0000">Inflammatory bowel disease</span>'''
*# '''<span style="color:#ff0000">Radiation enteritis</span>'''
*# '''<span style="color:#ff0000">Bladder dysfunction or outlet obstruction</span>'''
* Before the surgical procedure, a full mechanical and antibiotic bowel preparation is often used
* The length of the ureteral defect is measured, and an appropriate segment of distal ileum is chosen. The segment should be ≥15 cm away from the ileocecal valve
* In the presence of a scarred or intrarenal pelvis, ileocalicostomy may be performed
* Patients with worsening metabolic abnormalities associated with a progressively dilating ileal ureter should be evaluated for vesicourethral dysfunction.
* '''<span style="color:#ff0000">Malignancy arising from an ileal ureter segment has been reported and it is recommended that regular endoscopic examination be performed starting at postoperative year 3 for early detection</span>'''