Ureteral Substitution

First described in 1909, the ileal ureter has become the most accepted and studied form of ureteral substitution.9 Complications include early extravasation with fistula or urinoma formation and obstruction from edema, mucous plugging, or kinking of the loop. Ischemic necrosis of the loop has also been described and should be suspected in a patient with significant, unexplained pain postoperatively. Although the majority of patients have no metabolic consequences, hyperchloremic metabolic acidosis can develop, especially in patients with preexisting renal insufficiency (serum creatinine >2mg/dL). It also should not be performed in a patient with a history of inflammatory bowel disease or radiation enteritis.

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