Name of the Procedure:

Ureteroneocystostomy
Common Name(s): Reimplantation of the ureter, Ureteral reimplantation
Technical Term: Anastomosis of single ureter to bladder

Summary

Ureteroneocystostomy is a surgical procedure where a ureter (the tube that carries urine from the kidney to the bladder) is reattached to a different location on the bladder. It's done to correct problems with urine flow or to repair damaged ureters.

Purpose

This procedure typically addresses conditions such as ureteral obstruction, vesicoureteral reflux (VUR), or injury to the ureter. The goal is to restore the normal flow of urine from the kidney to the bladder, prevent urinary infections, and protect kidney function.

Indications

• Severe vesicoureteral reflux (VUR)
• Ureteral strictures or blockages
• Ureteral injuries (e.g., due to trauma or surgical complications)
• Recurrent urinary tract infections related to VUR or strictures

Preparation

• Patients may need to fast for several hours before surgery.
• Adjustments to medication regimens might be required, especially if blood thinners are used.
• Preoperative diagnostic tests may include imaging studies such as ultrasound, CT scan, or a voiding cystourethrogram (VCUG).
• Blood tests and urine analysis.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision is made in the lower abdomen.
3. Dissection: The surgeon locates the affected ureter.
4. Transection: The ureter is cut near its attachment to the bladder.
5. Reimplantation: The ureter is reimplanted into a new site on the bladder wall.
6. Anastomosis: The ureter is stitched into the bladder, creating a secure connection.
7. Closure: The incision is closed with sutures or staples.

Tools and technology include surgical instruments and possibly laparoscopic equipment for minimally invasive approaches.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Usually performed in a hospital's operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant

Risks and Complications

• Infection
• Bleeding
• Injury to nearby organs
• Ureteral stricture or obstruction at the reimplantation site
• Urine leakage
• Blood clots

Benefits

• Improved urine flow from kidney to bladder
• Reduction in urinary tract infections
• Preservation of kidney function
• Relief from symptoms associated with urinary obstruction

Recovery

• Hospital stay of 2 to 4 days for monitoring.
• Instructions for wound care and activity restrictions.
• Pain management typically includes prescribed medications.
• Follow-up appointments to monitor healing and function.
• Avoid strenuous activities and heavy lifting for several weeks.

Alternatives

• Endoscopic treatment (e.g., ureteral stent placement)
• Antibiotic prophylaxis for recurrent infections
• Observation with regular follow-up in less severe cases

Each alternative has its pros and cons, with surgery generally being more definitive but more invasive.

Patient Experience

• During the procedure: The patient is under general anesthesia and will not feel anything.
• Post-procedure: Discomfort and pain at the incision site are managed with pain medications. Patients may experience some bloating and should anticipate a gradual return to normal activities.
• Pain management strategies include prescribed pain relievers and, possibly, use of anti-inflammatory medications.