Name of the Procedure:

Ureteroureterostomy
Common name: Ureteral reimplantation

Summary

Ureteroureterostomy is a surgical procedure where one segment of the ureter is connected to another segment to bypass a damaged or obstructed part of the ureter. This operation allows urine to flow properly from the kidney to the bladder.

Purpose

Medical condition or problem it addresses:

• Ureteral obstruction
• Ureteral injury
• Ureteral strictures
• Ureteral tumors

Goals or expected outcomes:

• Restore normal urine flow
• Relieve pain and discomfort
• Prevent kidney damage

Indications

Symptoms or conditions warranting the procedure:

• Recurrent urinary tract infections
• Flank pain
• Hematuria (blood in urine)
• Hydronephrosis (swelling of a kidney due to urine build-up)

Patient criteria:

• Evidence of ureteral obstruction via imaging
• Failed conservative treatments (e.g., stents, medication)

Preparation

Pre-procedure instructions:

• Fasting for at least 8 hours prior to surgery
• Adjustments to current medications, particularly blood thinners
• Preoperative clearance from a primary care physician or a specialist if needed

Diagnostic tests or assessments:

• Blood tests
• Urine analysis
• Imaging studies (e.g., CT scan, MRI, Ultrasound)

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision is made in the abdomen or through minimally invasive laparoscopic techniques.
3. Isolation: The surgeon isolates the affected segment of the ureter.
4. Resection: The damaged or obstructed section is removed.
5. Reconnection: The healthy ends of the ureter are then sutured together.
6. Closure: The incision is closed with sutures or staples.

Tools and equipment:

• Surgical sutures
• Laparoscope (for minimally invasive approach)
• Ureteral catheters

Duration

The procedure typically takes 2 to 3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

Common risks:

• Infection
• Bleeding
• Urine leakage

Rare complications:

• Ureteral stricture formation
• Kidney dysfunction

Management of complications:

• Antibiotics for infections
• Additional surgical interventions if necessary

Benefits

• Restoration of normal urinary flow
• Relief from symptoms such as pain and recurrent infections
• Preservation of kidney function

Benefit realization:

• Benefits are generally noticed shortly after recovery from surgery.

Recovery

Post-procedure care:

• Pain management with prescribed medications
• Encouragement to maintain a small amount of physical activity to promote recovery

Expected recovery time:

• Hospital stay of 2 to 3 days
• Complete recovery within 4 to 6 weeks

Restrictions and follow-up:

• Avoid heavy lifting and strenuous activities for at least 4 weeks
• Follow-up appointments to monitor recovery and ensure the new ureter connection is functioning properly

Alternatives

Other treatment options:

• Ureteral stent placement
• Nephrostomy tube
• Endoscopic ureteral dilation

Pros and cons of alternatives:

• Ureteral stent: Less invasive but may require frequent replacements.
• Nephrostomy tube: Diverts urine externally, affecting quality of life.
• Endoscopic dilation: Minimally invasive but less effective for severe obstructions.

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel anything.

After the procedure:

• Some pain and discomfort at the incision site
• Possible need for a catheter temporarily
• Pain management through medications to ensure comfort

Pain management and comfort measures:

• Prescription pain relievers
• Ice packs to minimize swelling
• Encouraging adequate hydration