Introduction: Early descriptions of the ileal ureter date back to the late 19th century. While this was an innovative technique to address ureteral substitution, multiple complications were reported, and novel methods to address them continue to be studied today. We review the history and evolution of the ileal ureter and subsequent surgical advancements. Methods: A comprehensive literature review was performed in conjunction with our University’s librarian (LH). We used PubMed to identify contemporary medical literature, ILLiad to access archived texts and old surgical and urological textbooks to obtain additional historical information and references. Results: The first use of ileum to replace ureter was described in 1888 by Tizzoni and Foggi in a canine model. Fenger, in 1893, proposed the concept in humans. The first successful in vivo procedure was reported by Shoemaker in 1909 in a two-stage model. The patient was a young woman suffering from tuberculosis who had a solitary kidney. Her strictured ureter was replaced with ileum which was brought to the skin much like an ileal conduit initially. Subsequently, it was anastomosed to the bladder. This was the basis for modern ileal ureter. In 1940, Nissen reported a similar case and in 1950, Muller attached the ureters to a loop of ileum that was anastomosed to the bladder in a woman with bilateral iatrogenic ureteral injuries due to gynecologic surgery for uterine malignancy. For a case of bilateral stenosis, Foret and Heugshem replaced both ureters with a single segment of ileum in 1953. In 1959, Goodwin reported a case series of various configurations of ileal ureters. As experience with bowel reconstruction for ureters increased through the 1960s and 1970s, complications became more apparent and resulted in refinements including metabolic, reflux, and minimally invasive techniques. Conclusions: Though the complications associated with this procedure have led to novel surgical advances, the modern ileal ureter utilizes the same method as first described more than a century ago. SOURCE OF Funding: None
