*Purpose: Kidney transplantation in patients with previous urinary diversion is a surgical challenge. In patients with ileal conduit, ureteral anastomosis is not standardized.

*Methods: The technique was performed in 4 patients with urinary diversion at the time of kidney transplantation. Extraperitoneal approach was employed with standard vascular anastomosis on the right lower quadrant of the abdomen in 3 and left in 1. A finger was placed into the stoma to indicate the extraperitoneal location of the ileal conduit. For continent pouch, a Foley balloon was served as an indicator. Ureteral implantation was placed to the distal conduit with a stent.

*Results: Among the 4 patients, 3 are male and 1 is female with a median age of 43.6 (33.6-54.5) years old. The causes of end-stage renal disease are obstructive uropathy from the urinary diversion in 3 and calcineurin toxicity in 1. Two of the patients were on hemodialysis and 2 were pre-emptive. The reasons for creation of ileal conduit were neurogenic bladder in 3 (2 from multiple surgeries for vesico-urinary reflux and 1 from spinal bifida) and cystoprostatectomy in 1. The median duration of the diversion were 33 (20-49) years. The type of the diversion are ileal conduit in 3 and Indiana pouch in 1. Two patients received the kidneys from living donors and 2 from deceased donors. Median OR time was 308.5 (200-477) minutes with an EBL of 125 (100-200) ml. The ureteroenterostomy was successfully done without intra-operative complication. Two patient experienced post-operative complication with lymphocele and resulting in readmission. No delayed graft function was found and the creatine level before, 2-week post-OP, 4-week post-OP were 6.45, 1.34 and 1.15 respectively. Median length of stay were 3.5 (2-4) days. No ureteral stenosis was found in a median follow-up of 12 months.

*Conclusions: The finger technique is an easy technique to locate the pouch/conduit without opening the peritoneum. The outcomes of the small series are acceptable without major complication.

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