Cancer - Bladder, Pelvis, Ureter & Others(비디오) (V-008) 회장을 이용한 요관 대치술의 술기 양산부산대학교병원 비뇨의학과 이단비, 백승룡, 송원훈, 이승수, 박성우, 남종길 Introduction Ureteral defect of considerable length presents a complex challenge to urologic surgeons. The surgical options for management of complex long-segment ureteric defects are limited. Ileal ureter replacement is usually considered last as surgical method for extensive defects that are not amenable for reconstruction by typical techniques such as psoas hitch or Boari flap. Moreover, technical difficulties and surgical complications also contribute to the lack of extended use of the procedure. We present our experience of ileal ureter replacement with a video clip. Patient case We present a case of a female patient with long ureteral defect surgically treated with ileal substitution of the left ureter with an isoperistaltic ileal segment without detubularization. A woman of 32 years, without relevant past medical history, showed symptoms of lumbar pain and intermittent fever. She underwent surgery of placing a permanent ureteral stent (Uventa TM) 7 years prior to surgery due to multiple ureteral stricture events. Renal computed tomography demonstrated left hydronephroureterosis. We tried but failed to remove the permanent stent. We proposed a curative surgical procedure, which the patient agreed to undergo 3 weeks after the initial surgical attempt to remove the stent. The procedure was done using a midline incision, followed by medial mobilization of the decending colon, isolation of the left ureter and a section of the UPJ junction. We performed an enterectomy of 20cm of ileum (15cm away of the ileocecal valve), followed by a side-to-side ileal anastomosis. Next, we made a window between the sigmoid colon and the sacrum and we placed the ileal segment into retroperitoneum via this window. Finally, we checked the orientation of the ileal segment and performed anastomoses of the intact, isoperistaltic ileal segment at the level of the renal pelvis and at the level of the bladder. The patient had no perioperative complications. Currently, after 2 months of follow-up, the patient is asymptomatic, presents no urinary infections and has preserved renal function. Conclusion Ileal substitution of the ureter is a surgical technique that should be considered in cases of long ureteral defects when there are no other surgical options. keywords : Ureter, Urinary diversion, Ileum