Name of the Procedure:

Transureteroureterostomy (TUU) Anastomosis of ureter to contralateral ureter

Summary

Transureteroureterostomy (TUU) is a surgical procedure in which one ureter is connected to the opposite ureter. This is done to redirect the flow of urine when one ureter is damaged or blocked, allowing urine to bypass the affected area and flow normally from both kidneys to the bladder.

Purpose

TUU addresses conditions where a ureter is obstructed or damaged due to injury, disease, or surgical complications. The goal is to restore normal urine flow, preventing kidney damage and maintaining proper urinary function.

Indications

• Ureteral obstruction due to strictures, stones, or tumors.
• Damage to the ureter from trauma or surgery.
• Congenital abnormalities of the ureter.
• Persistent urinary tract infections due to ureteral issues.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjusting or stopping certain medications as instructed by the doctor.
• Pre-operative blood tests, imaging studies (such as CT scans or ultrasounds), and urine tests.
• Consultation with an anesthesiologist to discuss anesthesia options.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the ureters.
3. The surgeon identifies the damaged ureter.
4. The ureter is cut and mobilized.
5. A connection (anastomosis) is made between the cut end of the damaged ureter and the contralateral healthy ureter.
6. The connection is carefully sutured to ensure a secure and leak-proof join.
7. Stents may be placed temporarily to aid healing and urine flow.
8. The incision is closed with sutures or staples.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Urologist or surgeon
• Surgical nurses
• Anesthesiologist
• Supporting medical staff

Risks and Complications

• Infection at the surgical site.
• Bleeding or blood clots.
• Ureteral leakage or strictures at the anastomosis site.
• Kidney damage.
• Reaction to anesthesia.
• Postoperative pain or discomfort.

Benefits

• Restored urine flow from the kidneys to the bladder.
• Preservation of kidney function.
• Relief from symptoms associated with ureteral obstruction or damage.

Recovery

• Hospital stay for 3 to 7 days for monitoring and initial recovery.
• Instructions for wound care, pain management, and activity restrictions.
• Avoid heavy lifting and strenuous activity for several weeks.
• Follow-up appointments to monitor healing and remove any temporary stents.

Alternatives

• Percutaneous nephrostomy for temporary relief of obstruction.
• Ureteral reimplantation if the issue is near the bladder.
• Observation and medical management for mild cases.
• Each alternative has its own risks, benefits, and suitability depending on the patient's condition.

Patient Experience

• The patient will be under general anesthesia and should not feel pain during the procedure.
• Post-operative pain can be managed with prescribed medications.
• Some discomfort and restricted activity during the initial recovery period.
• Gradual improvement in urinary symptoms and overall well-being as healing progresses.