Calycovesicostomy, Ureterocalycostomy, and Ileocalycostomy: Rare Reconstructive Options for Transplant Ureteral Strictures

Background: Transplant ureteral stricture (TUS) reconstruction remains a significant challenge in renal transplantation, particularly when conventional access to the transplant ureter and renal pelvis is not feasible. This report presents two rare and complex surgical reconstructions: a combined calico-vesicostomy and uretero-calycostomy in one patient, and an ileo-calycostomy in another. Both cases involved patients with prior failed minimally invasive interventions and complex anatomy that precluded standard repairs. Case presentation: A hybrid surgical approach incorporating open reconstruction with fluoroscopic and endoscopic guidance was used to access the renal calyces directly, enabling successful re-establishment of urinary tract continuity. The first patient underwent dual reconstruction with native ureteral reimplantation to the middle calyx and a simultaneous calycovesicostomy, bladder to the It lower pole calyx. The second patient, with prior ileal conduit urinary diversion, underwent ileocalycostomy—anastomosing the ileal conduit to the middle calyx. Both reconstructions were performed using modified partial nephrectomies to preserve nephron mass. Long-term follow-up (34 and 40 months) demonstrated excellent graft function and minimal complications. Conclusions: These cases represent the first reported long-term outcomes of calycovesicostomy and ileocalycostomy in transplant ureteral reconstruction and reinforce the utility of calyceal access in complex TUSs. These cases highlight rare but viable surgical options in complex scenarios of transplant ureteral strictures. Hence, a multidisciplinary approach and meticulous preoperative planning are essential to optimize outcomes in these challenging scenarios.