Name of the Procedure:

Total Ureterectomy for Ectopic Ureter (Combination Abdominal, Vaginal, and/or Perineal Approach)

Summary

A total ureterectomy is a surgical procedure involving the removal of an ectopic ureter, which is a ureter that is not properly connected to the bladder. This procedure often requires a combination of abdominal, vaginal, and/or perineal surgical approaches to access and remove the aberrant ureter, and correct the associated anomalies.

Purpose

The procedure addresses a condition where the ureter, which is supposed to transport urine from the kidney to the bladder, is misrouted. The primary goals are to alleviate symptoms, prevent infections, and improve renal function by correctly removing the misplaced ureter.

Indications

• Persistent urinary incontinence due to ectopic ureter.
• Recurrent urinary tract infections (UTIs).
• Kidney damage or reduced kidney function stemming from the ectopic ureter.
• Failure of other less invasive treatments to correct the issue.

Preparation

• Patients are typically advised to fast for at least 8 hours before surgery.
• Instructions to stop taking certain medications, such as blood thinners, may be given.
• Pre-surgical diagnostic tests, including imaging studies like ultrasounds, CT scans, or MRI, and blood tests.
• Anesthesia consultation to plan for general anesthesia.

Procedure Description

1. The patient is placed under general anesthesia.
2. Surgeons make incisions in the abdominal, vaginal, and/or perineal areas to access the ureter.
3. The ectopic ureter is carefully dissected and removed.
4. Any defects or anomalies within the urinary system are repaired.
5. Incisions are closed with sutures and/or surgical staples.
6. The surgical site is dressed appropriately.

The procedure may utilize specialized surgical tools, including laparoscopes, scalpels, and retractors, as well as imaging technology for precision.

Duration

Typically, the procedure takes between 2 to 4 hours depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Urologist or specialized surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologists

Risks and Complications

• Common risks: bleeding, infection, pain at the incision sites.
• Rare risks: injury to surrounding organs, blood clots, anesthetic complications.
• Post-surgery complication management includes antibiotics for infections, pain relief medications, and monitoring for any immediate post-operative issues.

Benefits

Expected benefits include the resolution of symptomatic urinary incontinence, prevention of recurrent UTIs, and preservation or improvement of kidney function. Benefits can be realized shortly after recovery from surgery.

Recovery

• Hospital stay for a few days post-surgery for monitoring.
• Pain management with prescribed medications.
• Instructions to avoid strenuous activities for several weeks.
• Follow-up appointments to assess healing and address any concerns.
• Possible temporary use of a catheter to ensure proper urine drainage.

Alternatives

• Conservative management with medications and behavioral techniques.
• Minimally invasive ureteral reimplantation.
• Endoscopic treatments.
• Pros and cons: Less invasive options may have a shorter recovery time but might not completely resolve severe cases of ectopic ureter.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-operation, there may be discomfort and pain at the incision sites, which will be managed through pain relief strategies. Patients should anticipate a gradual return to daily activities over several weeks, along with periodic follow-up visits for recovery evaluation.