Ureteral reimplantation is a surgery that is done to fix the abnormality in the insertion of ureter in bladder maladjustment between the ureter and the bladder, that results in the reflux of urine. This reflux is known as vesicoureteral reflux (VUR). When the bladders cannot close properly, they force your urine to reflux back to the ureters or sometimes even to the kidneys. VUR is mostly seen in infants and young adults. If VUR is not treated through ureteral reimplantation, it might lead to urine infections and even kidney damage.
How is Ureteral Reimplantation performed?
Ureteral reimplantation is performed in the following way:
- The surgery takes 2-3 hours with full anaesthesia.
- Firstly, a small hole is made in the lower abdomen. Then, the doctor will detach the ureter and certain muscles from the bladder.
- The doctor will then decide where to reimplant the ureter in the bladder. Then, a tunnel will be created where the ureter will be placed.
- The doctor will then place the ureter at the new site in the bladder.
- Then the ureter will be secured with stitches in the bladder.
- If the other ureter needs treatment, it will be done at this time.
- The bladder will be stitched.
- The hole in the lower abdomen will then be closed, either through stitches or through surgical tapes.
- Lastly, a draining tube is placed close to the incision to remove any fluid build-up post-surgery.
Preparation for Ureteral Reimplantation
Pre-operative tests: Before the surgery, your doctor will advise certain tests like ultrasonography, ECG and certain blood tests to see if the patient is fit for operation.
When to get admitted to the hospital: Admission happens one day before the surgery.
Diet before the surgery: No solid food from midnight before surgery and no beverages from 2 hours before the surgery.
After the surgery, the nurse will check the blood pressure, wound and pulse regularly. The patient may be given a drip to ensure the right amount of fluid intake. A catheter will be placed for proper urine pass out. It might be blood-stained for 48 hours after the surgery.
Once the patient recovers from anaesthesia, they will be made to walk. Initially, they might be wobbly, therefore careful supervision is required. The doctor will prescribe pain relievers to manage the initial pain from the surgery. In the case of children, one parent is allowed to stay with the child.
Ureteral reimplantation is usually a safe procedure with very few risks involved. However, if complications arise, they might be:
- Blood in the urine
- Kidney infection
- Leakage of urine in the space surrounding the bladder
- Bladder spasms
- The ureters might get blocked
- The problem of urine reflux might not get fixed with the surgery
The patient is generally discharged on the second or third day post-surgery, but recovery usually takes one to two weeks post-surgery. One should refrain from doing any strenuous activity for at least four to six weeks after the surgery. If the patient is discharged with a catheter, it should be removed one-week post-surgery. If there is a drain, it should be removed 4 to 6 weeks post-surgery.
The patient may be given Tylenol or Ditropan to relieve pain during the recovery period. They will also be given antibiotics to speed up recovery and also avoid any infections. An ultrasound is generally performed one month after surgery to check whether there is any blockage at the surgery site. The patient will have a Voiding Cystogram (VCUG), 4-6 weeks post-surgery to check whether the problem of urine reflux is cured. If the results are normal, your child might discontinue antibiotics.
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