Name of the Procedure:

Ureteroneocystostomy with Extensive Ureteral Tailoring
Common Name(s): Reimplantation of ureter, Ureteral reimplantation
Technical Term: Ureteroneocystostomy with tailoring

Summary

Ureteroneocystostomy with extensive ureteral tailoring is a surgical procedure aimed at reattaching the ureter (the tube that carries urine from the kidney to the bladder) to the bladder. This is often necessary when there is damage or disease affecting the ureter, and significant shaping or resizing of the ureter is required to ensure proper function and urinary flow.

Purpose

Medical Condition: Addresses conditions such as ureteral obstruction, vesicoureteral reflux (backflow of urine from the bladder into the ureter), or damage from previous surgeries or injuries.
Goals: The procedure aims to restore proper urinary flow from the kidneys to the bladder, relieve symptoms like pain or infections, and prevent kidney damage.

Indications

Symptoms/Conditions:

• Recurrent urinary tract infections (UTIs)
• Persistent vesicoureteral reflux
• Ureteral strictures or obstructions
  Patient Criteria:
• Patients with unmanageable ureteral damage or disease that hasn't responded to less invasive treatments.

Preparation

Pre-Procedure Instructions:

• Patients may need to fast for 8-12 hours before the surgery.
• Certain medications may need to be adjusted or stopped.
  Diagnostic Tests:
• Imaging studies like CT scans or MRIs to assess the urinary tract.
• Blood tests to ensure patient readiness for surgery.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: An incision is made in the lower abdomen to access the bladder and ureter.
3. Ureteral Tailoring: The damaged portion of the ureter is removed, and the remaining segment is reshaped or resized to ensure a tension-free attachment.
4. Reimplantation: The tailored ureter is then reattached to a new site on the bladder.
5. Testing for Leaks: Ensuring the connection is watertight to prevent urine leakage.
6. Closure: The incision is closed, and a catheter may be inserted to drain urine during the initial recovery.

Tools & Technology: Surgical instruments specific to urological procedures, sutures, catheters.

Duration

The procedure typically takes 2-4 hours, depending on the extent of the tailoring required.

Setting

The procedure is performed in a hospital operating room, usually with inpatient admission.

Personnel

• Surgeon: Specializing in urology
• Anesthesiologist: Manages anesthesia and patient vitals
• Nurses: Assist during surgery and provide postoperative care
• Surgical Technicians: Prepare instruments and assist the surgical team

Risks and Complications

Common Risks:

• Bleeding
• Infection
  Rare Risks:
• Urine leakage from the connection site
• Stricture or narrowing of the reimplanted ureter
• Damage to surrounding organs
  Complications Management: Monitoring and potential additional surgeries or interventions if complications arise.

Benefits

• Expected Benefits: Improved urinary function, relief from symptoms, prevention of kidney damage.
• Onset of Benefits: Benefits are typically realized shortly after recovery, though full function may take a few weeks.

Recovery

Post-Procedure Care:

• Hospital stay for several days for monitoring.
• Pain management with prescribed medications.
  Recovery Time: Full recovery might take 4-6 weeks.
• Restrictions: Limitation on physical activities to allow healing.
• Follow-Up: Regular follow-up appointments to monitor recovery and function.

Alternatives

Other Treatment Options:

• Endoscopic procedures to open strictures
• Medical management for less severe reflux or obstructions
  Pros and Cons: Ureteroneocystostomy with tailoring provides a more definitive solution for severe cases compared to less invasive procedures but carries higher risks and longer recovery.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Postoperatively, patients may experience discomfort or pain at the incision site, which can be managed with medications. A catheter may cause some discomfort until removed. Full recovery will necessitate rest and avoiding strenuous activities as advised by the healthcare team.