Ileal Substitution of a Radiologically Injured Duplex Female Ureter via Novel Antireflux Technique Alexander Ivanov Hinev a＊ , Stoyan Milanov Paunov a , and Boyan Dobrev Balev b a Department of Surgeryｳ Division of Urologyｳ and b Department of Radiology ｳ “Stｴ Marina” University Hospital ｳ Varna Medical Universityｳ Varna 9010ｳ Bulgaria adiotherapy is an established and effective method of adjuvant treatment of gynecological malignanciesｴ Howeverｳ irradiation of the female pelvis may cause obstructive urological complications due to the formation of stenosis of the distal ureter(s) ｴ The Lich- Gregoir techniqueｳ psoas- hitch techniqueｳ Boari flapｳ and transureteroureterostomy are the most popular surgical techniques currently used to manage damages to the distal ureterｴ When large defects are encounteredｳ ureteral substitution by an isolated intestinal segment (ileumｳ colonｳ or appendix) may become the preferred optionｴ We present a case of iatrogenic injury to the dis- tal ureter following total hysterectomy with subse- quent pelvic irradiation for uterine malignancy in a 34- year- old female patient with a duplex kidneyｴ The damaged distant ureter was replaced by an isolated ileal segmentｴ Ureteroileal anastomosis was created in an antireflux manner by implementation of the serous- lined extramural tunnel techniqueｳ originally described in orthotopic bladder substitutesｴ Case Report A 34- year- old white female (MVTｳ medical record 21812/10ｴ 11ｴ 2004) presented in our clinic with the following medical historyｴ In November 2003ｳ the patient underwent pelvic surgery for cancer of the uterine cervixｴ A radical hysterectomy using the Wertheim- Meigs technique was performedｴ The his- tological result (Nosｴ 1554ﾝ61) confirmed differenti - atedｳ at some sites moderately differentiatedｳ scua- mous cell carcinoma infiltrating the whole depth of the uterine cervixｳ with tumor emboli in the blood vesselsｴ At surgeryｳ 12 lymph nodes were removedｳ 2 of which were found to be metastaticｴ R A 34- year- old female patient underwent total hysterectomy and pelvic irradiation for uterine malig- nancy, which led to iatrogenic fibrotic injury of the distal ureter. Reconstructive surgery was per- formed, and the ureter was replaced by an isolated ileal segment. Ureteroileal anastomosis was cre- ated using the antireflux serous- lined extramural tunnel technique, while the distal end of the isolated ileal segment was widely anastomosed with the bladder. Within a 1- year follow- up, excel - lent results were achieved, with complete recovery of the patient’s renal function and previous qual - ity of life. This technique could be a viable option when large ureteral defects are encountered. Key words : ureterｳ ileumｳ ureteral strictureｳ reconstruction Acta Med. Okayama, 2007 Vol. 61, No. 3, pp. 171ﾝ176 http:// www.lib.okayama-u.ac.jp/ www / acta/ CopyrightⒸ 2007 by Okayama University Medical School. Case Report Received August 16, 2006 ; accepted December 18, 2006. ＊ Corresponding author. Phone: ＋ 359ﾝ878ﾝ266125; Fax: ＋ 359ﾝ52ﾝ302884 E- mail: alexander_hinev@yahoo.com (A. Hinev)