Name of the Procedure:

Ureteroneocystostomy; with vesico-psoas hitch or bladder flap

Summary

Ureteroneocystostomy is a surgical procedure in which the ureter (the duct that carries urine from the kidney to the bladder) is reattached to the bladder. This technique can involve a vesico-psoas hitch or a bladder flap to provide additional support and ensure proper functioning.

Purpose

This procedure addresses urinary tract issues such as ureteral injuries, obstructions, or strictures. The goal is to re-establish a normal flow of urine from the kidney to the bladder, alleviate symptoms such as pain and urinary difficulties, and prevent kidney damage.

Indications

• Ureteral injuries due to trauma or surgical complications.
• Strictures or blockages in the ureter.
• Vesicoureteral reflux (backward flow of urine from the bladder to the kidney).
• Congenital abnormalities of the ureter.

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments in medications, including blood thinners, might be necessary.
• Pre-procedure diagnostic tests such as urine tests, blood tests, and imaging studies (e.g., ultrasound, CT scan) to assess the urinary tract.

Procedure Description

1. Anesthesia is administered to ensure the patient is comfortable and pain-free.
2. A surgical incision is made to access the ureter and bladder.
3. The affected segment of the ureter is isolated and removed or bypassed.
4. The ureter is reattached to the bladder, often utilizing a vesico-psoas hitch (a technique where the bladder is sutured to the psoas muscle) or a bladder flap for additional support.
5. A catheter may be placed to allow urine to drain during the healing process.
6. The incision is closed and dressed.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Urologic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgical site
• Bleeding
• Injury to surrounding organs or tissues
• Urinary leakage or fistula formation
• Blood clots
• Anesthesia-related risks

Benefits

• Restoration of normal urine flow
• Relief from symptoms such as pain and urinary retention
• Prevention of kidney damage
• Improved quality of life

Recovery

• The patient may need to stay in the hospital for a few days post-procedure.
• Pain management with medications.
• Instructions to avoid strenuous activities for several weeks.
• Follow-up appointments to monitor healing and ensure the ureter is functioning correctly.
• Removal of the catheter usually occurs in 1-2 weeks.

Alternatives

• Endoscopic procedures to remove blockages or strictures.
• Ureteral stents to keep the ureter open.
• Nephrostomy tube placement to divert urine externally.
• Conservative management with medications and monitoring.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Post-procedure, there may be discomfort or pain at the incision site, managed with pain medications.
• The patient may experience temporary urinary catheter use and should follow all care instructions to prevent infection.
• Gradual return to normal activities as per the surgeon’s advice.

Please note, it’s crucial for patients to discuss the specific details and any concerns with their healthcare provider to ensure they have comprehensive and personalized information tailored to their situation.