Ileal Ureter Reconstruction for Radiation-Induced Ureteral Stricture in a Patient with a Contracted Bladder

N. Behtash, K. Nguyen, S. Thomas, Z. Sadeghi

Radiation-induced ureteral stricture; Ileal ureter; Ureteral reconstruction; Pelvic radiation

Introduction: Pelvic radiation can cause progressive ureteral ischemia, fibrosis, and obstruction, making reconstruction diAicult when local tissue is severely scarred or lacks suAicient mobility for primary repair. In these settings, ileal ureter reconstruction may be a

viable option when conventional ureteral or bladder-based approaches are limited.

Case Presentation: We present the management of a 77-year-old man with a history of prostate cancer treated with pelvic radiation who developed severe distal left ureteral obstruction with marked proximal dilation, followed by nephrostomy tube placement.

Intraoperatively, dense post-radiation fibrosis and distorted tissue planes made ureteral identification and mobilization diAicult. Indocyanine green was administered through an existing percutaneous nephrostomy tube to identify the ureter and facilitate dissection. Following extensive ureterolysis, ureteroscopy confirmed a patent proximal and mid ureter without intraluminal pathology. The patient also had a markedly contracted bladder, which limited conventional bladder-based reconstructive options. Given the extent of distal ureteral disease and limited tissue mobility, an isolated ileal segment was considered to create a tension-free ureteroileal reconstruction. The distal ileal segment was detubularized and incorporated into bladder augmentation, with vascularized tissue coverage placed over the reconstruction. Intraoperative leak testing was negative. The nephrostomy tube was removed 1 month after surgery, and imaging at 6 months showed no hydronephrosis or hydroureter.

Discussion: This case highlights the role of ileal ureter reconstruction in complex radiation induced ureteral obstruction when fibrosis, poor tissue quality, and limited mobility make primary repair diAicult. Careful assessment of the remaining ureter and surrounding tissues is essential when selecting a reconstructive approach. In appropriately selected patients, ileal ureter substitution can restore urinary continuity and provide durable upper urinary tract drainage despite a severely fibrotic pelvis.

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