Name of the Procedure:

Ureteroneocystostomy; anastomosis of duplicated ureter to bladder

Summary

Ureteroneocystostomy is a surgical procedure that involves attaching a duplicated ureter to the bladder. This procedure addresses urinary issues caused by having an extra ureter, which can lead to complications like urinary tract infections or kidney damage.

Purpose

• Medical condition: Treats problems arising from a duplicated ureter, such as frequent urinary tract infections (UTIs) or obstruction.
• Goals: To re-establish proper urine flow, reduce infection risks, and preserve kidney function.

Indications

• Symptoms: Frequent UTIs, flank pain, abnormal urine flow, or kidney infection.
• Patient criteria: Usually performed on patients with a duplicated ureter causing significant medical issues.

Preparation

• Pre-procedure instructions: Patients may need to fast for several hours before the surgery and make adjustments to their regular medication routine as advised by their healthcare provider.
• Diagnostic tests: Imaging tests like ultrasound, CT scan, or MRI; urine tests; possibly a cystoscopy to visualize the bladder and ureters.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made in the lower abdomen.
3. Access: The surgeon locates the duplicated ureter.
4. Transection: The duplicated ureter is divided from its current position.
5. Reimplantation: The ureter is then reattached (anastomosed) to the bladder in a new location.
6. Closure: The incision is closed with sutures or staples.
   • Tools: Scalpel, surgical clamps, sutures, and possibly laparoscopic instruments.

Duration

The procedure typically takes 2 to 3 hours.

Setting

This surgery is usually performed in a hospital setting.

Personnel

• Primary surgeon (urologist)
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

• Common risks: Bleeding, infection, blood clots.
• Rare risks: Injury to surrounding organs, ureteral stenosis (narrowing), urine leakage.
• Management: Monitoring, antibiotics for infection, additional surgical intervention if necessary.

Benefits

• Expected benefits: Reduction in UTIs, improved urine flow, and prevention of kidney damage.
• Realization: Benefits can typically be seen within weeks after surgery once recovery is underway.

Recovery

• Post-procedure care: Hospital stay usually required for several days; prescribed pain relief and antibiotics.
• Recovery time: Full recovery may take a few weeks to a few months.
• Restrictions: Limited physical activity during the initial recovery period; follow-up appointments for monitoring progress.

Alternatives

• Non-surgical management: Long-term antibiotics for infection control.
• Other surgical options: Ureteroureterostomy (joining the duplicated ureter to the normal one).
• Pros and cons: Non-surgical options may not address the root cause; other surgeries may have different outcomes or risks.

Patient Experience

• During procedure: The patient will be under general anesthesia and will not be aware of the surgery.
• After procedure: Discomfort and pain managed by medications; possible temporary catheterization to assist with urination. Most patients feel back to normal within a few weeks but should follow all medical advice for optimal recovery.