A total of four patients underwent ureteral replacement using ileum without the antireflux mechanism for extensive ureteral loss from 1985 to 1995. The indications included surgical trauma, retroperitoneal fibrosis, ureteral obstruction due to abscess, and ureteritis. One case had bilateral reconstruction. The followup interval ranged from 3 to 14 years. Urinary infections were noted in 2 cases. One patient, who had urinary infections and neurogenic bladder, had symptoms, but, in all cases, serum creatinine was unchanged or decreased and the pyelogram was normal or showed mild hydronephrosis. Thus, the procedure was considered successful in all cases. This procedure provides excellent long-term results for reconstruction of ureter when the normal ureter cannot be used. Creation of the antireflux mechanism may not be necessary in patients with normal renal function.